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library of
(EI|e llntDcrsity of Hortl] Carolina
C O L L K C TI O X OF
NORTH C A R O L I N I A X A
K X D O W E D BY
J O H X S P R U X T PI I L I.
of the class of 1889
This book must not
be token from the
Library building.
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Form No. 471
IBTTIL.I^El'XIISr
OF THE
Morth Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G.Thomas, M.D.,Prcs,, Wilmington. \ W. P. Ivey, M. D Lenoir.
S. Westray Battle, M. D...Asheville. Francis Duffy, M. D New Bern.
Henry W. Lewis, M. D Jackson. { W. H. Whitehead, M. D Rocky Mt.
J. L. XiCHOLSOx, M. D Rich lands. , J. L. Ludlow, C. E Winston.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigli.
Vol. XVII. APRIL, 1902. No. 1.
Biological Examinations Once More.
Very few counties have availed them-selves
of our offer to deposit with the
Superintendent of Health apparatus for
mailing specimens in cases of suspected
diphtheria and of fevers upon the re-quest
of even one physician in the county.
This offer remains open. If desired we
will make a deposit with the medical
health officers of the cities and towns.
Promptness is .so all-important in
diphtheria that in those counties which
have no mailing cases on deposit physi-cians
should telegraph directly to the
Biologist, Mr. G. McCarthy, for mailing
cases. Application should also be made
directly to him in fever cases. For spu-tum
and water analyses, to the Secretary
of the Board of Health.
The instructions must be rigidly car-ried
out or the examination cannot be
made.
Disinfection and Prevention in tbe
Siek-room.
BY CHARLES HAKKINGTOX, .M. D., BOSTON.
Upon the discovery that he has to deal
with a case of one of the diseases com-monly
denominated contagious, the phy-sician
directs that the patient be iso-lated,
and that so far as is possible all
infectiotis matter be so treated that it is
robbed of its power to work injury to
others. Whether the results of his fore-sight
will be what they should be or a
jjositive injury is largely dependent upon
the care and thoroughness with which the
preventive measures are instituted and
carried out, for it can hardly be denied
that half-way meai^ures or the unintel-ligent
carrying out of proper directions,
with the consequent lulling into a sense
of safety, may be productive of as much
harm as absolute neglect of all precau-tions
other than those dictated to one
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
and anollier individual by a knowledge of
possible personal danger.
The measures recommended for safe-guarding
the health of others in time of
sickness comprise isolation, prevention
of dissemination of infectious material,
and disinfection, and these, I predict,
will lie enforced at no distant day by
all intelligent communities not alone in
the so-called contagious diseases, but in
all diseases of a serious nature spread
directly or indirectly by any of the ex-cretory
products of the body. Out of
deference to the controversy over the
right of the two words infectious and
contagious to have separate and distinct
meanings, I will here declare the sense
in which I employ them. Infectious dis-eases
include all those which depend upon
the presence of micro-organisms in the
tissues, while the contagious class of in-fections
diseases includes those trans-missil)
le from man to man by direct
contact or close proximity. We do not
commonly reckon typhoid fever, for in-stance,,
as a contagious disease, but when
we read that of 206 cases of that disease
investigated by Dr. Herbert Peck, 28, or
13.6 per cent., were traced to direct in-fection
in the sick-room, we must agree
witJi him that the danger is more com-mon
than is generally supposed, and that
it lias not received the attention that it
deserves. Lobar pneumonia and pulmon-ary
tuberculosis are also not included
in tjie contagious class, and yet we are
not insensible of the fact that house
epidemics of the former are not uncom-mon,
and that the latter is largely spread
by overcrowding and lack of ventilation.
It is not my intention to enter here
upon any discussion of the important
question of the advisability of enforcing
wkat may be regarded as unnec'"«sarily
liarsh measures for the suppression of tu-berculosis,
nor to touch upon the exten-sion
of supervisfon by public authority of
the handling of the sick, but rather
to consider the efficiency of preventive
measures already practised.
Isolation.—The object of isolation is
to remove tlie patient as completely as
possible from all chance of acting as a
menace to the health of others, whether
dwelling beneath the same roof or not.
In the dwellings of the poor it is usually
most difficult and frequently impossible
to isolate the patient in a proper man-ner
because, primarily, of lack of space;
in the homes of the well-to-do and of
the rich, where plenty of room is avail-able,
it is not uncommonly the case that
isolation is a mere farce because of fail-ure
on the part of the family to grasp
the full importance of thoroughness, in
spite of instruction by the attending phy-sician
and by the representative of the
local authority. In the minds of many,
isolation is complete when the patient is
in a room by himself, with the door lead-ing
therefrom into the hall open or shut
according to no particular rule, but ac-cording
as accident has left it. To such
minds the air of a sick-room is a deadly
contagion to which the doorway, not
the door, opposes itself as a most effi-cient
barrier. We all have met and
know the person well who says, "I was
very careful not to enter the room, but
talked with him from the doorway."
Often the door is left open, and its place
is taken by a sheet wetted occasionally
by some disinfectant solution. To this
thin obstacle, with more or less of open
space below and at the sides, the mor-bific
agents supposedly in the air are
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
presumed to attach themselves as the
natural processes of ventilation set the
air in motion from the room outward ; or,
if not this, the agent with which the
sheet has been wetted, perhaps hours
ago, is supposed to exert a purifying in-tiuence
upon every particle of passing
air. Under either of these conditions,
if infective matters are floating in the
lir of the sick-room there is no reason
.vhy they should not he carried to all
parts of the house. Even shutting the
door may not accomplish all tnat is de-sired
in respect of preventing efflux of air
from the sick-room to other parts of
the house, as can be shown by a most
simple experiment. Between the bot-tom
of the door and the threshold there
is usually a fair-sized interval through
which under the ordinarily existing dif-ferences
of temperature, and, therefore,
of density, a constant stream of air is
passing inward or outward. If one holds
a lighted match near this space, the
flame, if the air is in motion, is in-clined
one way or the other according
as the leakage is away from or toward
the room. Sometimes the current is so
strong that the match is extinguished.
This may seem to be a small matter, or,
indeed, insignificant, but under some cir-cumstances
it may well be thought
worthy of some extra care, in which case
sand-bags, such as are used on window
sashes, may be found serviceable.
In those cases in which aerial infection
is supposed to occur the ideal place for
isolating the patient is an upper floor or
an L which can be shut off" entirely from
the rest of the house, and ventilated
thoroughly by direct communication with
the outer air. Where such an area is
not available, the room should be closed
as completely as possible, and the im-mediately
adjoining rooms should be
kept well aired. In the class of cases
in which aerial infection under ordinary
careful attention to the excretory pro-ducts
is not to be expected, such exten-sive
inecautionary measures are not nec-essary,
and here the main points to be
considered are the prevention of dissemi-nation
of infective material and the best
method for the immedaite destruction of
the morbific agents as they are yielded
by the patient.
Frcvention of Dissemination.—It is
quite unnecessary to dwell upon the pre-cautions
always observed by careful, ex-perienced
practitioners against the car-riage
of infective material by themselves
from the sick-room, but it may not be out
of piace to mention the carelessness dis-played
by the thoughtless but enthu-siastic
beginner whom we all have seen
leaning down upon the mattress and bed-clothes,
supporting himself by his hands,
examining whatever attracts his atten-tion,
whether it be the body of the pa-tient
or the vessel containing the excre-tory
products, and ever and anon strok-ing
with his now possibly infected hands
his hair and beard, or rubbing them
against his own clothing or that of his
neighbor, or hiding them in his pockets.
Such carelessness on the part of the
nurse in attendance would be contrary to
licr training, and on the part of the stu-dent
or young practitioner is equally con-trary
to the instruction which he is sup-posed
to have received. Absolute care in
tins particular is imperatively necessary
on the part of all who visit or are in at-tendance
in the sick-room.
In preparing the room for the recep-tion
of the patient, it should be borne in
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
mind that the less furniture there is
present, the less there will be to undergo
the process of disinfection on the ter-mination
of the sickness. Above all, the
carpet should be removed at the very
outset, and all upholstered furniture
and draperies with it. Ordinary dusting
and broom sweeping, which stir up the
dust so thoroughly, should be absolutely
interdicted, and cleaning and wiping
with mops and cloths not wet, but well
moistened with a disinfectant, should
be substitiited.
The used bed linen, the patient's body
linen, the napkins, towels and other
cloths that may become infected may be
put to soak in disinfectants at once and
on the spot, or may be placed within cot-ton
bags wet with disinfectant, and con-veyed
at the proper time to the kettle,
into which, without further handling
and without opening, the whole is placed
and then boiled for an hour.
The uselessness of attempting aerial
disinfection in the presence of the pa-tient
is not apparently as well recognized
as it should be. The placing of small
amounts of chloride of lime, carbolic
acid, iodine, sulpho-naphthol anu other
disinfectants in saucers and other open
dishes, and distributing them about the
room, has no other effect than the pro-duction
of odors which may be an annoj--
ance to the patient. If disinfection could
be so easily accomplished, the local
boards of health would be relieved of
much work and very large expense. With
the agents at present available for ger-micidal
action, aerial disinfection in the
presence of the patient is absolutely im-possible,
for they must be used in such
concentration as- to be quite irrespirable.
But we must not overlook the disinfect-ant
power of direct simlight and the
beneficial effects of constant dilution of
the impurities of the air by proper ven-tilation.
The latter is materially as-sisted
l)y the maintenance of an open
tire when climatic conditions will not
permit cross ventilation by means of
open windows, and thus practical utility
and the conferring of cheerfulness are
combined.
The attention on the part of the nurse
to hands, hair, clothing, etc., and the
frequent necessity of providing separate
outfits of eating utensils for the patient,
and of destroying all unused portions of
his meals, need no more than passing
mention.
Disinfection of the Excretory Products.
—The materials which require thorough
disinfection include those from the
mouth, throat and nose in diphtheria
and whooping-cough ; from tne lungs in
influenza, pneimionia and plumonary tu-berculosis;
from the skin in the acute
exanthemata, especially during desqua-mation:
vomitus in yellow fever and,
conditionally, in other diseases; stools in
cholera, dysentery, typhoid fever and tu-bercular
conditions of the alimentary
canal ; and the urine in typhoid fever,
and perhaps, also, in some of the exan-themata.
These may be destroyed in
two ways, according to circumstances.
Those in not too large bulk and not too
iluid, such, for example, as sputum and
discharges from the nose, mouth and
throat, received on cloths, may be most
effectually disposed of by burning, if
tliere is a fire immediately at hand.
Bulky matters, stich as stools, urine and
vomitus, and objects actually or possi-bly
infected by them, such as bed-cloth-ing,
body linen, etc., which must be puri-fied,
but not destroyed, must be brought
into intimate contact with some disin-
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
fectant which fultllls the requirements of
a good germicide, namely, that it shall
kill all forms of bacteria and spores
within reasonable limits oi time, shall
not lie made inert by organic matters
with wiiich the bacteria are associated,
and shall not subject the attendant to
any dangerous consequences. If, in ad-dition,
it be cheap, free from disagreeable
odor, and incapable of injuring cotton,
linen and other textiles either by caus-ing
stains or by reducing their strength,
so much the better. Where shall we find
such an agent ? Shall we find it in the
shops put up in pints and quarts with at-tractive
labels which reveal or not, ac-cording
to the maker's fancy, the nature
of the acti\e ingredient ? No, we are not
likely to find it there; at least, that is
my experience.
In IMarch last Dr. Richard M. Pearce
and myself reported at a meeting of the
Boston Society of Medical Sciences the
results of our examinations of such pro-prietary
disinfectantsj as we could find
in the apothecary shops of Boston, and
it may not be out of place to report them
again in condensed form at this time,
for the brands obtained and examined in-clude
several that are held in high es-teem
by the profession generally. The
list included the following: Marsh's In-stantaneous
Disinfectant, Disinfectine,
Ozonos, Bromochloralum, Royal Disin-fectant,
Excelsior Disinfectant, Phenol
Sodique, Hovey's Chloride of Zinc, Piatt's
Chloride, Carbolic Purifying Powder, and
Solution of Chlorinated Soda. These weie
tested with anthrax spores, typhoid cul-tures,
typhoid stools, diphtlieritic mem-brane
and tuberculous sputum. The
mixlure of material and disinfectant was
intimate, and the length of time of the
contact was in each case two hours. So
far as demonstrating efficiency is con-cerned,
the results were distinctly disap-pointing,
for but one of this list was suc-cessful
in more than half of the ten tests
to which each was subjected, and this one
failed in three. One of them failed eight
times, another nine times, and three
failed every time. Not one of them was
successful in sterilizing the tuberculous
sputum. Those which failed in all the
tests were Carbolic Purifying Powder,
Koyal Disinfectant, and Phenol Sodique.
Those that failed eight and nine times,
were, lespectively, Hovey's Chloride of
Zinc and Bromochloralum.
In justice to the makers of these pre-parations,
it must be said that in no
sense can any of these disinfectants be
properly classed as a fraud, for chemical
analysis shows tnat they are one and
all composed of substances that are gen-erally
regarded as disinfectants, and are
so leccmmended in many of our stand-ard
works on public health. The sub-stances
found include chloride of zinc,
cliloride and sulphate of aluminum, alum,
permanganate of potassium, salts of
lead, iron and copper, neutral tar oils,
hydro-chloric and nitric acids, and others.
We must, therefore, believe that they are
manufactured and sold in good faith.
But even so, we cannot use disinfectants
that kill almost every time, or that kill
only occasionally; they must kill every
time, and we must therefore look else-where.
Shall we use corrosive sublimate? Its
action on many substances with which it
may come in contact, the readiness with
which it is thrown out of solution made
inert by matters associated with the bac-teria,
and its very poisonous character,
6 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
make this agent unreliable for general
purposes and undesirable. Shall we use
caustic lime? Lime is a good disinfect-ant,
but it has its disadvantages. It
must be used in the freshly slakfed state;
it must be applied in very considerable
amounts; it must be very intimately
mixed with the material to be disinfected,
for it is not very capable of self-mixing;
and after it has periormed its office, it
must be disposed of in such a way as to
cause no trouble. How to ao this in a
city block may be quite a problem. One's
first impulse would suggest throwing it
into the water-closet, but such disposal
would simply create work for the
plumber, for the pipes would soon be oc-cluded.
Moreover, lime cannot be used
for purifying linen and otner textiles.
Chlorinated lime is open to all the ob-jections
that apply to lime, and the ad-ditional
one of having a very disagree-able
odor. Where, then, shall we turn ?
In addition to the agents already men-tioned,
we tried a five-per-cent. solution
of carbolic acid, sulpho-naphthol, and a
somewhat similar substance which I will
designate solution B, both in five-per-cent,
strength, and two-and-one-half-per-cent.
solution of formalin, one per cent,
formaldehyde. Of these the first-men-tioned
has for years been a favorite
stand-by, objectionable to some on ac-count
of its odor, and recommended for
general purposes in two, three and five-per-
cent. strength. It killed the bacilli
in the sputiun, but was successful only
once in five trials with typhoid cultures
and stools and diphtheritic membrane.
The sulpho-naphthol solution, which can-not
be praised for its odor, was also suc-cessful
with sputum, and it supra ssed
the carbolic solution in efficiency by scor-ing
two successes in five other trials. The
remaining two preparations were uni-formly
successful, though it must be said
that they were tried only six times each,
twice with typhoid cultures, twice with
typhoid stools, and once each with spu-tiun
and membrane. Our previous in-vestigations
with formaldehyde, however,
seemed to us to make further tests un-necessary,
and as to the solution B, it
has a most disagreeable odor and is,
moreover, a patented article. I will not
mention its true name because I have no
doubt as to one use to which this paper
would be put, and because I have no de-sire
to have even the appearance of
writing •'reuling notices. I have no
hesitation in mentioning formaldehyde,
even thoug'i an enterprising concern in-terested
in its sale makes it a practice to
reprint, without permission, any articles
which nay serve its purpose. All for-maldehyde
is good, however, and, so far
as I know, that sold by one is no better
than that furnished by another.
Formaldehyde possesses all the quali-fications
of a good disinfectant, as men-tioned
above. In diluted form it has no
lurpleasant odor, it causes no injury to
fabrics, it makes no stain, it is not as
expensive as the cheapest of the proprie-tary
preparations, and, most important,
it kills every form of micro-organism
with which it is placed in direct con-tact.
I do not wish to be understood as as-serting
that there are no other efficient
disinfectants than formaldehyde, but it
happens that I cannot speak of them
from the stand-point of personal experi-ence.
Doubtless there may be others as
good, but it would be difficult to con-ceive
a superior. Ten years ago Frankel
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
demonstrated the superiority of the cre-sols
over carbolic acid, and within the
past two years a number of preparations
containing them in their variousisometric
forms and in various combinations have
been phiced upon the market. They liave
been extensively studied, and the origi-nal
conclusions of Frankel ha^-e been
confirmed again and again, but the most
favorable reports tlius far published pre-sent
no results which entitle them to ad-mission
to the class with formaldehyde.
A recent j^^^^lication by Seybold, who
investigated and compared a number of
aifferent preparations, shows that not
one of them is effective against anthrax
spores, whicn we know are quickly de-stroyed
by formaldehyde. It is but fair
to add that solution B, which we found
to be so successful with stools, mem-brane
and s;^putum, contains a consider-able
percentage of cresols.
Besides the cresols, various other or-ganic
substances have been extensively
exploited within recent times, but each
one seems to fail in some one or more
particulars.
Whatever tlie disinfectant used in the
sick-room, its application must be in no
niggardly amount, for in practical dis-infection
extravagance is a greater vir-tue
than too strict economy. The in-fected
objects should be submerged in the
solution so that the agent shall come
into contact with the entire mass. In
the case of stools, urine and vomitus,
at least an equal volume of the disin-fectant
sliould be added and the wliolc
should be carefully mixed. Although
in the case of formaldehyde the destruc-tion
of the organisms is accomplished in
a much shorter time, it is best to con-tinue
the exposure for about two hours,
thus erring, if at all, on the side of
safety. At tlic end of two hours, the
sterilized excretory matters may be fin-ally
disposed of by way of the water-closet,
and the bed linen and similar ar-ticles
sent to the wash-tub. There
seems to be no particular and good rea-son
for supplementing complete destruc-tion
of pathogenic organisms with any
further process of disinfection, but if it
suits one's ideas of necessity, the cus-tomary
prolonged boiling can, at least,
do no harm.
—
Boston Medical and Hurgi-cat
Jonrrutl in Sanitorian.
Review of Diseases for February, 190^.
XI.\ETY-OXE tOlXTIES REPORTI.XG.
Ninety-four counties have Superinten-dents
of Health.
Except in the case of the more conta-gious
and dangerous diseases the Super-intendent
has, as a rule, to rely upon his
own information alone, since few phy-sicians
can be induced to report oases of
non-contagious diseases to him.
Where the number of cases is not given
or the prevalence of a disease otherwise
indicated, its mere presence in the county
is to be understood as reported.
For the montli of March ihe follow-ing
diseases have been reported from the
comities named
:
Measles.—Allegliany; Beaufort, two
cases; Bertie, many; Brunswick; Cas-well,
several ; Clevehmd, a few ; Cum-berland,
a few; Durham, a great many;
Cranvillc, 12; Harnett, a few; John-ston,
several: Mecklenburg, 10; Moore,
several; New Hanover, 1; Onslow, 10;
Orange, a few; Person; Eandolph, a
few; Richmond, in all parts; Kobeson;
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Rockingham: Rowan, C; Scotland, many;
Surry, 6; Swain; Union, 10; Wake. 2;
Wilkes, (5—28 connties.
Whoopixg-cough.—Beaufort, 2 : Bruns-wick;
Caswell, several; Cleveland, a few;
Davidson; Durham; Granville, 15; Har-nett,
a few: Hertford; Hyde. 50; John-ston,
several; ^Mecklenburg; Moore, a
few; Northampton, many; Perquimans,
12; Person, many; Randolph, a few;
Rutherford, a few; Sampson, in all
parts; Scotland, several; Union, 20;
Wake, 2—22 counties.
Scarlet Fever.—Alleghany; Ashe, 3;
Buncombe, 2; Caswell, 3; Catawba, 2;
Stanly, 6; Watauga, 6—6 counties.
Diphtheria.—Ashe, 5 ; Bladen, 1
;
Craven, 1; Cumberland, a few; Lenoir.
2; New Hanover, 1; Rockingham; Ruth-erford,
2; Wake, 1; Wayne. 1—10 coun-ties.
Typhoid Fe\'er.—Ashe, 1 ; Cleveland,
2 or 3 ; Columbus, 2 ; Craven, 1 ; Gates,
1 ; Granville, 4 ; Greene, 1 ; Harnett, a
feW; Johnston, 1; Jones, 1; Nash, 2;
Onslow, 1; Polk, 2; Randolph, 3; Rock-ingham;
Rowan, 2; Stokes, 1; Swain, 3;
Union, 12; Wake, 4; Watauga, 4—21
counties.
Malarial Fever.—Bladen, Caswell,
Chowan, Greene and Halifax.
Malarial Fever, Pernicious.—Bla-den,
2.
;Malari.\l Fever, Hemorrhagic.—
Chowan, 1 ; Greene, 1.
IxFLiEXZA.—Bladen, general; Bruns-wick;
Caswell; Columbus; Da\adson;
Gatpp; Graham; Greene; Henderson ;Hert-ford.
general; Iredell, a few; Lincoln,
general; Montgomery; New Hanover;
Northampton, general: Onslow, a few:
Orange, general; Person; Robeson;
Stokes; Transylvania; Yancey—22 coun-ties.
Pneumonia.—.\lexander; Bladen, in all
parts; Burke; Caswell; Chowan; Clay, in
all parts; Gates; Graham; Greene, in
all parts; Guilford; Halifax; Harnett;
Hj'de, in all parts ; Iredell, 1 ; Montgom-ery,
15; Moore, in all parts; Perqui-mans,
4; Person; Polk; Randolph; .Samp-son,
in all parts; Transylvania; Union;
Yancey—24 counties.
Mumps.—Alexander, in all parts; Al-leghany;
Davidson; Person; Rocking-ham,
in all parts; Scotland; Washing-ton,
in all parts; Watauga; Wayne,
several; Wilkes; Yadkin—11 counties.
Rheumatism.—Columbus, more than
usiial.
V.vricella.—Davidson; Lenoir; Pen-der,
1; Wilson, 1.
Small-POX.—Buncombe, 5; Burke, 2;"
Cabarrus, 9; Caldwell, 2; Cherokee, 3;
Cleveland, 2; Cumberland, 1; Durham, 2;
Forsyth, 3; Franklin, 4 (?); Gaston, 27;
Graham, 9, Greene, 1, from Wilson
—
"There have been no cases in the region
infected a year ago" ;Henderson,l; Iredell,
a number among negroes in the eastern
part; Johnston, 1; Lenoir, 1, none now
(April 9) ; Lincoln, 5, last case dis-missed
March 26; Mecklenburg, 35;
Nash, 5; New Hanover, 1; Richmond, 3;
Rockingham, 3; Rowan, 5; Rutherford,
2; Sampson, 2; Stanly, several, all now
discharged (April 8); Wilson, 69, 4
deaths—28 counties.
Cholera, ix Hogs—Chowan, Hert-ford.
Infll'enza, IX Horses.—Polk.
Rabies, in Dogs.—Iredell.
Staggers—Hvde.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 9
Xo diseases of importance reported
from Alamance, Anson, Carteret, Curri-tuck,
Davie, Duplin, Edgecombe, Hay-wood,
McDowell, Madison, Martin, Pas-quotank,
Pitt. Vance and Warren.
No reports from Chatham and Mitchell.
The Rocky 3Ioiiiitaiu Iiiclnstrlal
Sauatorlnin.
Before the organization of this institu-tion
was perfected we expressed our ap-preciation
of the probable usefulness of
the projected sanatorium. We have
.since had gratifying accounts of its pro-gress,
and we now learn that it is well
advanced in its actual work. A card re-cently
issued bears the statement that up
to the time of the publication of the
card, which is not dated, forty-four pa-tients
had been cared for, of whom thir-teen
had been wholly and eleven partly
self-supporting. The existence of an in-stitution
in which such results have al-ready
been accomplished seems to us to
add materially to the resources within
the reach of those subjects of incipient
tuberculous lung disease who lack the
means of paying in full the cost of their
maintenance and treatment, and we hope
the day is close at hand when such re-sources
will be vastly multiplied.
A scheme has recently been announced
which promises to augment considerably
the availability of this particular sana-torium
for certain classes of persons,
namely, the organization of what is
termed the Sanatorium Press Auxiliary,
The plan involves the publication of "a
magazine to ije the organ of the .sena-torium,
and to furnish its readers with
information as to matters pertaining
to the maintenance and restoration of
health. It is proposed ihat all the work
of preparing the magazine, "e.xcept the
actual handling of the issue after it
comes ii'om the press," shall be done
l»y persons who are under treatment in
the sanatorium. Such an arrangement,
it will be seen, seems to carry with it
the opportunity for many a poor writer,
illustrator, compositor, proof-reader, or
jiressman to lake the treatment rccpiired
liy Ills impairment of health, without a
total loss of income. It will, of course,
take time for this scheme to l)e put into
actual operation, for a special building
and a complete printing plant will have
to be provided. We presume that all
that is expected of the magazine is that
it will pay expenses, account being taken
of the prestige it may serve to give the
sanatoriiun, and it ought not to l)e very
difficult, we should think, to hit upon
similar plans that would benefit workers
in various other lines than that of litera-ture.
That, in deed, seems to be the es-sential
feature of an industrial sana-torium,
and the community will expect to
see it carried otit as completely as possi-ble,
regard always being paid to the avoid-ance
of unfair competition with the regu-lar
trade on the strength of having been
able to obtain "lungers* " labor cheap.
We feel sure that the managers of the
Kocky Mountain Industrial Sanatorium
will not make the mistake of following
any other course, and we shall look with
much interest for the results of their
venture.
—
Xeic York Medical Journal.
Summary of Mortnarj- Repoi-ts for
Marcli, 190-J.
(twexty-nine towxs).
Aggregate popula- White. CoVd. Total.
tion 92,800 61,750 154,550
Aggregate deaths.. 134 117 251
Representing tem-porary
annual
death rate per
1,000 17.3 22.6 19.6
Causes of Death.
Typhoid fever 3 2 5
Scarlet fever 10 1
Whooping-cough... Oil Measles . 1 I
Pneumonia 29 23 52
Consumi>tion 21 21 42
Brain diseases 5 2 7
Heart diseases 10 9 19
Neurotic diseases... 3 14 Diarrhceal diseases 2 13 All other diseases.. 56 51 107
Accident 3 2 5
Suicide 1 I
Violence 3 3
]:'.4 117 251
Deaths under five
vears 23 33 od
Still-born 1 » y
10 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
I^ortuary Report for JMarch, 1902.
Towns
AND RePOKTEBS.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 11
County Superintendents of Healtli.
Alamance Dr. H. R. Moore.
Alexander Dr. C. J. Carson.
Alleghany Dr. B. C. Waddell.
Anson Dr. J. H. Bennett.
Ashe Dr. J. W. Colvard.
Beaufort Dr. Jno. G. Blount.
Bertie Dr. H. V. Dunstan.
Bladen Dr. L. B. Evans.
Brunswick Dr. J. A. McNeill.
Buncombe Dr. E. B. Glenn.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. A. A. Kent.
Camden
Carteret Dr. F. M.Clark.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. H. T. Chapin
Cherokee Dr. J. W. Patton.
Chowan Dr. T. J. Hoskins.
Clay Dr. J. O. Nichols.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr. N. li. Street.
Cumberland Dr. Jno. D McRae.
Currituck Dr. H. M. Shaw.
Dare .Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James McGuire.
Duplin Dr. O. F. Smith.
Durham Dr. N. M. Johnson.
Edgecombe Dr. L. L. Staton.
Forsyth Dr. John Bynum.
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. 0. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. D. Booth.
Greene Dr. Joseph E. Grimsley.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. Green.
Harnett Dr. O. L. Denning.
Haywood Dr. S. B. Medford.
Henderson Dr. J. G. Waldrop.
Hertford Dr. J. H. .Mitchell.
Hyde Dr. E. H. Jones.
Iredell Dr. Henry F. Long.
Jackson Dr. Wm. Self.
Johnston Dr. L. D. Wharton
Jones Dr. S. E. Koonce.
Lenoir Dr. C. L. Pridgen.
Lincoln Dr. T. F. Costner.
McDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. S. McLaughlin.
Mitchell Dr. V. R. Butt.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. D. C. Parris.
Pamlico
Pasquotank Dr. J. E. Wood.
Pender Dr. R. J. Williams.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing
house.
Polk Dr. Earle Grady.
Randolph Dr. S. A. Ilenlev.
Richmond Dr. Wm. P. S. Webb.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford Dr. T. B. Tvvil y.
Sampson Dr. R. E. Lee.
Scotland Dr. A. W. Hamer.
Stanly Dr. V. A. Whitlev.
Stokes Dr. W. V. McCanlesa
Surry Dr. John R. Woltz.
Swain Dr. J. A. Cooper.
Transylvania Dr. C. W. Hunt.
Tyrrell
Union Dr. John M. Blair.
Vance Dr. Goode Cheatham.
Wake Dr. J. J. L. McCullera
Warren Dr. A. S. Pendleton.
Washington Dr. W. H. Ward.
Watauga Dr. T. C. Blackburn.
Wayne Dr. Williams Spicer.
Wilkes Dr. W. P. Horton.
Wilson Dr. W. S. Anderson.
Yadkin Dr. M. A. Royall.
Yancey Dr. J. L. Ray.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 13
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board.
Have any of the following diseases occurred in your practice during the month
just closed. If so, state number of cases.
Whooping-cough — Typhoid Fever
Measles Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever -- Cerebro-spinal Meningitis-
What have been the prevailing diseases in your practice?
Has any epidemic occurred among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks:
M, D.
.190-— N. C.
:B"criLiL:ETii>T
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G. Thomas, M. D., Pres.,AVilmington.
S. Westray Battle, M. D...Asheville.
Henry W. Lewis, M. D Jackson.
J. L. Nicholson, M. D Richlands.
W. P. IvEY, M. D Lenoir.
Francis Duffy, M. D New Bern.
\V. H. Whitehead, M. D Rocky Mt.
J. L. Ludlow, C. E Winston.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh
Vol. XVII. MAY, 1902. No. 2.
Meeting of tbe Board.
The annual meeting of the Board will
as usual be held at the same time and
place as that of the State Medical So-ciety,
which this year will meet at Wil-mington,
-June 10—13. The conjoint ses-sion
with the Medical Society will as-semble
at 12 M. Wednesday 11th. It
is very much to be desired that all the
health officers of the State should get
together at least once a year, and we sin-cerely
hope that every superintendent of
health in the State will exert himself to
be present. The meeting promises to be
an interesting and enjoyable one, and we
feel sure that those who attend will be
fully repaid fur the trip.
Bovine Tuliercalosig.
Since Koch's expression at the London
Tuberculosis Congress of the opinion that
tuberculosis in man and tuberculosis in
the cow were not the same disease and.
therefore, non-transmissible from one to
the other, the question has excited the
greatest interest. It is still suh judice,
however, and practical health officers
have thought it wisest to continue their
work on the supposition that it is trans-missible
from cow to man. In this con-nection
our Biologist, Mr. McCarthy of
the Department of Agriculture, has made
a bacteriological test for tubercle bacilli
of sixty-seven samples of milk from
dairies in all parts of the State. In only
one in.stance did he find the bacillu.s and
it was absent from a secoml sample from
that herd. A tuberculin test of the herd
demonstrated its freedom from tubercu-losis.
The first sample must have been
infected accidentally from outside. This
sjieaks well for our milk supplies, but
it would be more satisfactory to know
that the dairy herds had stood the tuber-culin
test successfully. Some years ago
we advised that all cities and towns for-
16 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
l>id the sale of milk within their limits
from infected herds, but it met the fate
of much good advice even from higher
sources. If the question should be set-tled
against Koch we promise ourself to
make another move on that line.
Mr. McCarthy desires us to state that
he will probably take his vacation in
June, in which event the biological labo-ratory
would be closed during that
month, as he has no assistant, unless one
should be provided by the Board of Agi-i-culture
at its meeting on May 27th. We
hope that some arrangement may be
made to prevent a hiatus in the work.
The Emibalmer in His Relation to
Infections Diseases.
Read before the State Funeral Directors' and
Einbalmers' Association, May 14, 1902,
BY RICHARD H. LEWIS, M. D.,
Secretary North Carolina Board of Health.
The prime object of the State, through
its General Assembly of 1901, in creating
the State Board of Embalming was the
protection of the public health. This is
shown by. the fact that the majority of
the Board were required to be members of
the State Board of Health. At the same
time the claims of the embalmer's calling
were recognized in making two of the
five members "practical embalmers."
And this is as it should be, for while I
would not minimize in the least the na-tural
and praiseworthy sentiment of rev-erence
for the dead, it still remains that
the only practical value to the living of
the art of embalming consists in prevent-ing
to some extent the spread of infec-tious
and contagious diseases by the
prompt destruction in the dead botly of
the germs which cause them. The re-sponsibility,
therefore, resting upon the
embalmer called to prepare, for transpor-tation
especially, the remains of one dead
of an infectious disease is very great.
And this responsibility is shared by the
Board of Embalming, and through it by
the State Board of Health likewise, inas-nuich
as the license to perform this im-portant
work is derived from them. The
realization of this responsibility on the
part of the two boards, of both of which
1 happen to be a member, accentuated by
my experience in the examination of ap-plicants
for license to practice embalm-ing,
is the reason for my presenting this
paper to your honorable association.
From the answers given by some of the
applicants to questions bearing upon dis-infection
it was very apparent that the
instruction received by them on that sub-ject,
from some at least of the teachers
of embalming, was very faulty and ut-terly
inadequate—the process recom-mended
amounting to no disinfection at
all. Disinfection to be effective must be
very thoroughly done, no detail, how-ever
small, being omitted.
While it might be claimed by the em-balmer
that his duties cease witn the dis-infection
and embalming of the corpse, as
a matter of fact he is in many instances
practically the only one available to dis-infect
the room and its contents, and a
thorough knowledge of the best methods
is therefore justly demanded of him, even
if he should refuse to do the work. But
of course no embalmer of the right spirit
would decline if called upon by the
family to do it. Indeed, I very much
hope that not only all licensed embalm-ers,
but all undertakers as well, will fit
themselves by the acquirement of the
necessary knowledge and apparatus for
doing this work. In a large majority of
cases of death from infectious disease the
BULLETIN OF. THE NORTH CAROLINA BOARD OF HEALTH. 17
body is not embalmed, and only the
work of the undertaker is in demand,
but the necessity for the thorough disin-fection
of the remains and of the room
and of all its contents remains the same.
There is no reason why every imdertaker
should not be a skilled disinfector,
thereby adding to his own income and
at the same time doing a valuable ser-vice
to his community. I would be glad
to see the word ''Disinfector" added to
the business sign of every funeral direc-tor
in the State. A total outlay of less
than twenty dollars would provide every-thing
necessary in the way of apparatus
and materials: a disinfector's suit (or-dinary
overalls, with coat well buttoned
and collar turned up, trousers long and
wide enough to cover the feet, and a few
yards of cheese cloth to envelope Ihe
head, neck and lower part of the face,
leaving only the eyes exposed, would an-swer
very well) ; a Lentz formaldehyde
generator ( I recommend the Lentz merely
because it is the cheapest of its class,
and good enough) ; a supply of formalin,
bichoride of mercury and carbolic acid;
and a book of instructions. I can cor-dially
recommend an excellent little man-ual
entitled "Disinfection and Distin-fectants,"
prepared by my friend, Dr. H.
^I. Bracken, Secretary of the State Board
of Health of Minnesota, and published by
the Trade Periodical Company of Chicago
at a cost of $1. The subject we have un-der
consideration is so well treated by
Dr. Bracken that I feel that I cannot do
better than to quote liberally from his
book—as I now proceed to do:
THE DISINFECTOR.
"\^Tien the time comes for the disin-fection
of the sick-room and its occu-pants,
a most important duty is to be per-formed
in order to protect the general
public, and none but trained and con-scientious
disinfectors should be en-trusted
with this duty. Unfortunately,
it too often happens that when the plTy-sician's
duties cease, those of the under-taker
begin. It is certainly important,
therefore, that he should know what to
do and liow to do it, for by doing the
right thing he not only protects him-self,
but the public at large. It may
be that it is necessary for him to give
immediate attention to the remains of
the dead. If so, his suit should be
moistened and put on and his mouth
and nose protected by some covering.
The remains should then be properly
washed with a disinfectant and injected
with a reliable disinfecting fluid.
"It is much better, when possible, after
death from small-pox, scarlet fever,
diphtheria, etc., to use formaldehyde as
an aerial disinfectant in the room where
tlie remains are lying before doing any-thing
with the dead body itself. When
this is not possible the greater care will
be necessary on the part of the under-taker
for the protection of himself and
others. After the remains have been
cared for the room and its contents must
be further disinfected by some competent
person—this may be a phjsician, a
trained nurse, a trained disinfector or
the embalmer. It is not often that a
physician is willing to do this work. In
many instances there is no trained nurse
or disinfector at hand. The embalmer
is undoubtedly the best one in many in-stances
to be entrusted with this work.
If he undertake the task, he should be
familiar with the responsibility resting
upon him and should perfoi'm his duties
as a disinfector conscientiously. First an
aerial disinfectant should be used in the
18 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
room and the best one is undoubtedly for-maldehyde.
After this formaldehyde disin-fection
the room should be entered;
all personal clothing and bedclothing
should be placed in an antiseptic solu-tion
prior to washing, or placed in a
pile for further treatment wdth formal-dehyde,
or burned. Carpets, furniture,
wood-work, walls, floors, etc., must be
disinfected as directed further on. Finally
the room must be freely aired out before
being again used for habitation.
SPECIAL DISINFECTION.
"1. Of Clothing.—All articles of cloth-ing
from the patient or his bed that are
not injured by soaking in a disinfecting
solution can safely be treated by boil-ing
or steaming, and such precautions
should always be taken. In fact, the
use of the disinfecting solution should be
looked upon as only temporary protec-tion,
to be depended upon only until
such time as disinfection by boiling or
steaming can be carried out.
"2. Of Rooms.—All windows and doors,
except one for the exit of the dis-infector,
should be closed and sealed
with strips of paper pasted OA-er the
cracks" (and the throat of the chimney
should be tightly closed by packing with
old grain bags, paper, or whatever will
surely prevent the escape of the gas, un-less
the fire-place is small enough to
permit its satisfactory closure by past-ing
a sheet of strong paper OA^er it).
"When all is in readiness to liberate the
disinfecting gas, the disinfector should
finally withdraw from the room, closing
tightly the door or AvindoAv from which
he makes his exit" (sealing its cracks
from the outside)
.
"\Yhen sulphur is "sed as the disin-fectant
the folloAving course should be
pursued: Place a large wash-tub par-tially
filled Avith boiling water in the
centre of the room. In this tub of hot
AA-ater place an iron kettle resting upon
bricks or some other solid substance. In
the kettle place a quantity of crushed
brimstone (ten pounds for each thou-sand
cubic feet of space) and pour over
this some alcohol (about four ounces).
When all is ready light the alcohol on
the sulphur and AvithdraAv from the room.
The water in the tub serA'es a double pur-pose:
(1) It protects from the danger
of fire spreading from the burning sul-phur
and alcohol in the kettle. (2) It
supplies moisture in the room—a neces-sity
Avith sulphur disinfection.
"In the use of formaluehyde as a disin-fectant
it is best to choose an apparatus
that can be operated from the outside
of the room, the gas being conducted into
the room through the key-hole or other
small aperture." (The articles in the
room should be so spread out and ar-ranged
as to permit the free access of
the gas)
.
"The room should be kept closed for
a period of at least five or six hours after
the introduction of the disinfectant.
"Further disinfection of the contents
of the room: After aerial disinfection
the contents of the room or house should
be divided into three groups:
" ( a ) Articles that can be disinfected by
boiling or Avashing.
'•(b) Articles that can be disinfected
by further treatment with formaldehyde.
"(c) Articles that must be burned.
"W'ashable clothing, sheets, etc., should
be placed for a time in a five per cent,
solution of carbolic acid in AA-ater." (A
one per cent, solution of formaldehyde
(one part of formalin to forty of AA-ater),
or a one to one thousand solution of
bichloride of mercury (in a icooden xes-
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 19
sel) would be equally as good). "They
should then be removed and boiled for
at least a half-hour.
"Certain articles, presenting a free sur-face
and not too thick, such as carpets,
blankets, curtains, etc., can be made com-paratively
safe by thorough disinfection
with formaldehyde. Furniture that will
stand washing, such as plain chairs, ta-bles,
bedsteads, etc., should be washed
with a solution of corrosive sublimate in
water, one part in one thousand. Up-holstered
fm-niture, mattresses, pillows,
feather beds, and all articles that would
be spoiled by such methods of disinfec-tion
as have already been described,
should be burned.
'•'Further disinfection of the room:
After the removal and disinfection of
the contents of a room the room itself
should receive careful attention. If the
walls are papered the paper should be
soaked off with a one to one thousand
parts solution of corrosive sublimate in
water, and the walls, windows, wood-work,
floors, in fact, everj-thing about
the room, should be washed with a simi-lar
solution. It is a good plan to re-paint
all woodwork." (Walls of a suit-able
character should be wliite-washed,
or caloomined).
"After everj-thing has been thoroughly
disinfected, still further precaution
should be taken by allowing the most
complete ventilation possible of the room.
Articles of clothing or furniture should
be placed in the open air and exposed to
the sunlight, if possible, for several
days.
"3. Of the Dead.—This is a very im-portant
duty; otherwise disease may be
spread far and wide. The remains of all
those who die of an infectious disease
should be thoroughly injected with a re-liable
embalming fluid; all external ori-fices
should be securely closed with ab-sorbent
cotton; and finally, the entire
surface of the body, including the hair,
should be thoroughly cleansed with a re-liable
disinfectant, such as a solution of
corrosive sublimate (one in one thou-sand
parts of water), or of carbolic acid
(one in twenty parts of water). With
such precautions taken the shipment of
bodies may be permissible as governed
by the rules given elsewhere.
"The importance of giving such careful
attention to the remains of all who die
of an infectious disease cannot be too
strongly emphasized.
"Often there is no wish to remove the
remains at the time from the place of
death to some remote point, and the
burial is made without thorough disinfec-tion
of the body. At some later period,
for some reason or other, the wish for re-moval
may arise, -but then it will be too
late, for the remains of one who has died
of dangerous infectious disease and
buried without proper disinfection im-mediately
following death, cannot be
safely disinterred.
"It maj' be well, while dealing with
this stibject, to state that very few of the
so-called disinfecting embalming fluids on
the market will stand the bacteriological
test. It is a difficult but not impossible
task to find an embalming fluid that has
both good disinfecting and cosmetic
qualities.
"Another important fact to bear in
mind in the use of embalming fluids la
the necessity of thorough injection. The
common tendency is to use an insufficient
quantity of fluid. Enough can be in-jected
only under pressure. Such pressure
shotild be constant, as secured from a
compressed air apparatus or the fountain
20 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
syringe or irrigator, placed with its bot-tom
at least six feet above the point of
insertion for the injecting canula or
needle. The bulb syringe can never be
a reliable instrument for use in embalm-ing."
I do not advise disinfection by sulphur
fumigation, for while it may be effective,
and is effective if sufficient sulphur is
burned in the presence of abundant mois-ture,
it is not altogether so certain as
formaldehyde, and besides has the serious
objection of bleaching colored fabrics, as
carpets, curtains, woolen clothing, up-holstered
furniture, etc., all of which can
be successfully treated with formalde-hyde
at the same time the room is dis-infected.
Disinfection with formaldehyde can be
accomplished by other methods than the
one indicated, as, for example, the
Chicago method of spraying sheets sus-pended
in the room ^\^lth formalin, or the
generation of the gas by the burning of
wood alcohol in various apparatus, as
the Kuhn generator, as well as in other
ways. On the whole, however, the
method recommended, that is, by the use
of generators of the type of the Lentz,
the Mulford, the Kny-Scheerer, the Parke,
Davis & Co. and the West, all of which
can be operated from the outside under
constant supervision, is in my judgment
the best.
I beg to express the hope—and for the
Board of Health and the Board of Em-balming,
the wish—that the methods
above set forth, which practically cover
the subject of disinfection in its rela-tion
to the embalmer and the under-taker,
be strictly observed by all mem-bers
of your calling, especially by all li-censed
embalmers. The Board of Em-balming
in granting license guarantees
to the people of our own State and of
other States the competency of its licen-tiates,
and it should therefore be assured
not only of the possession on their part
of the requisite knowledge of the sub-ject,
but also of the disposition to apply
it honestly and conscientiously. Of
course if it should appear that any li-censed
embalmer fails to meet these re-quirements
in his practice it would be-come
the painful duty of the Board to re-fuse
to renew his license.
The responsibility resting upon the em-balmer
and undertaker in relation to in-fectious
diseases is very great, but I am
confident that it is only necessary to
call attention to the grave importance of
the matter to insure the conscientious
performance of the duty.
Tent Liife for Consumptives.
As soon as the weather will permit
and proper locations can be selected
there will be pitched near Boston the
first of a number of camps for consump-tives.
This camp (and each succeeding
camp Avill be like it) will consist of ten-
2)iano-box tents, arranged in a circle
with an open-air fire in the center, and
surrounded by a duck wall eight feet
high. Each of these tents will be a con-sumptive's
home, a consumptive will sleep
there, even through the coldest weather^
with no other protection than plenty
of felt blankets, felt sleeping boots, and
a two-gallon jug of hot water.
The tents are made of twelve-ounce
duck, are only seven feet high, with four-foot
walls, boxed in around the bottom
a foot from the ground. They will be
lined with weather paper. The flaps will
open toward the fire, the ten tents mak-ing
a little circle about a clean gravel
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 21
court. Ill the duck Avail \vhich sur-rounds
the whole will be a single en-trance.
The people who live there will
wear one heaA-y suit night and day. They
will each of them take one quick soapless
bath a week, and will eat three good
hearty meals a day, with coffee in the
morning and hot chocolate any time of
the day or night. Their bill of fare
will include milk, eggs, vegetables, bread
and butter, and meat—chiefly beef, mut-ton,
or pork, broiled on spits before the
fire or roasted in the embers, or broiled
down into soup.
This open life is expected to cure them
of their disease. The method is the re-sult
of experiments made last winter in
a tent on Huntington avenue by a scien-tist
whose name has not yet been di-
A-ulged. This gentleman pitched his
tent during the coldest part of a Jan-uary
which was more than usually cold,
and stayed in there \intil the early
spring, engrossed in his experiments,
but finally seeing patients and announc-ing
that he wanted as many consump-tives
as possible to prove the truth of his
theories.
He wants the consumptives still. His
theory has been pretty well tested now,
but he still wants as many consumptives
as Avill come to him—the worse their
condition the better—to put them in his
settlements.
"The life there," he said, "quickly
fortifies a man's bodily powers; it en-volutes,
then evolutes man back toward
ancestral or wild life. The skin, nails,
and hair toughen and thicken; pul-monary
catarrh stops: hemorrhages
cease. A civilized man loses his sensi-tiveness;
his emotions change. He be-comes
insensitive and fearless. All his
energy goes to nutrition; his intellectual
centers are dormant. All his powers are
concentrated in building and repair. He
falls asleep at twilight and wakes at
dawn, ready to eat. Incidental disaster
affects him little; he changes from a
hothouse plant to an oak. The fear and
panic customary to a crowd of consump-tives
no longer affect him, and thus the
greatest danger of hospitalism is avoided.
"Baron Larry Nap, chief surgeon and
adviser, made this same observation in
his Egyptian and Russian campaigns:
that incipient consumptives make the
best soldiers. They have Spartan cour-age,
and army life, properly regulated,
will cure them. A regiment of consump-tives
would be no mean enemy."
The camps are merely for the purpose
of scientific investigation, and if a pa-tient
cannot a fiord the expenses he will
be taken free. The camps will all be
near the city, where scientific physicians
are within call.
—
Boston Transcript, in
loica Health Bulletin.
Review of Diseases for April, 190"3.
EIGHTY-SIX COUNTIES REPORTING.
Where the number of cases is not given
or the prevalence of a disease otherwise
indicated, its mere presence in the county
is to be understood as reported.
For the month of April the follow-ing
diseases have been reported from the
counties named
:
Measles.—Anson, several cases; Beau-fort,
epidemic; Bladen, 4; Brunswick,
many; Cabarrus, 4; Caswell, 50;
Chatham, many; Currituck, several;
Durham, many; Forsyth, many; Gran-ville.
25; Guilford, 2; Harnett, a few;
Johnston, many; Jones, several; Macon,
a few: Mecklenburg; Moore, several;
Randolph, a few; Rockingham, many;
Rowan. 5; Scotland, several; Swain, 15;
Wake. 14; Wayne, 1; Wilkes, 3; Yadkin,
2—27 counties.
22 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Whooping-cough.—Alamance, 30 ; Beau-fort,
10; Bertie, many; Cabarrus, 6; Cas-well,
50; Dare, 5; Da\'idson, several;
Durham, several; Granville, 8; Harnett,
a few; Hertford, 25; Hyde, 25; Meck-lenburg;
Montgomery, 25; Moore, a few;
Northampton, epidemic; Pasquotank, 2;
Pitt, in all parts; Randolph, general;
Sampson, a great many; Scotland, a
few; Stokes, 1; Union, 16—23 counties.
Scarlet Fever.—Catawba, 7; Guil-ford,
1 ; Mecklenburg ; Xew Hanover, 1
;
Rowan, 3; Watauga, 10—6 counties.
Diphtheria.—Bladen, 1 ; Catawba, 1
Lenoir, 1; Mecklenburg; Xew Hanover, 1.
Typhoid Fe\'er.—Chatham, many
Cleveland, 3 ; Columbus, 1 ; Gates, 1 ; Gra-ham,
4 ; Greene, 1 ; Guilford, 1 ; Har-nett,
a few; Montgomery, 2: Moore, 5;
Nash, 1 ; New Hanover, 1 ; Rockingham,
a few ; Rowan, 3 ; Scotland, 3 ; Stanly, 1
;
Vance, a few; Wake, 2; Watauga, 6
—
19 counties.
]VL\LARIAL Fever.—Bertie, Bladen, Cas-well,
Chowan, Cumberland, Currituck,
Dare, Gates, Greene, Hyde, Jones, Mar-tin,
Onslow, Person, Sampson, Union,
Vance and Wayne—18 counties.
Malarial Fe\'er, Pernicious.—Dare,
2; Jones, 1.
Malarial Fe\'er, HEiiORRHAGic.—Cho-wan,
1; Gates, 1; Greene, 1; Martin, 1;
Union, 5.
Bo^vEL Diseases.—Bladen, Catawba,
Gaston, Onslow and Pasquotank.
Influenza.—Brunswick ; Caswell, in
nearly all parts; Dare, several; Gates;
Pender, a few; Perquimans, a few; Ran-dolph,
in all parts; Stokes; Wake, in
all parts; Wilkes; Yadkin—11 counties.
Pneumonia.—Alexander, in all parts;
Anson; Bladen; Chatham, many; Curri-tuck,
1 ; Franklin, a few ; Gaston, 1
;
Gates, 3; Harnett, many; Haywood, seve-ral;
Lenoir; Perquimans, a few; Pitt, in
all parts; Randolph, in all parts; Vance,
in all parts; Wake, in all parts; Wayne,
Yadkin—-18 counties.
Mumps.—Davidson; Gram-ille; Iredell,
in all parts; McDowell, a few; Onslow,
a few; Person; Rockingham; Stanly;
Watauga; Wilkes—10 counties.
Varicello—Carteret, many; Sampson,
in nearly all parts.
Small-pox.—Beaufort, 1 ; Burke, 1
;
Cabarrus, 6; Caldwell, 1; Caswell, 3; Ca-tawba,
1; Davie, 1; Forsyth, 6; Gaston,
several; Guilford, 1; Iredell, 8; Lincoln,
1; McDowell, 3; Mecklenburg, 56; Nash,
7; Rockingham, 28; Rowan, 8; Ruther-ford,
2; Union, 1; Wake, 2; Wilson, 11;
Yadkin. 6—22 counties.
Cholera, in Chickens.—Clay, Gates
and Onslow.
Cholera, in Hogs.—Chowan.
Staggers, in Horses.—Currituck and
Hyde.
No diseases reported from Ashe, Bun-combe.
Clay, Duplin, Edgecombe, Gra-ham,
Henderson, Jackson, Madison,
Mitchell, Polk, Transylvania and War-ren.
No reports received from Alleghany,
Cherokee, Cleveland, Halifax, Orange,
Richmond, Surry and Washington.
Snnimarj- of Mortuary Reports for
April, 1903.
(twenty-seven towns).
Aggrec^ate popula- T^^^^- <^»^'^- Total.
i\on. 89,800 60,850 150,650
Aggregate deaths.. 103 97 200
Representing tem-porary
annual
death rate per
1,000 13.8 19.1 15.9
Causes of Death.
Malarial fever Oil Whooping-cough... 2 13 Measles 3 14 Pneumonia 14 18 32
Consumption 18 16 34
Brain diseases 7 18 Heart diseases 6 9 15
Neurotic diseases... 14 5
Diarrhoeal diseases 3 2 5
All other diseases.. 45 39 84
Accident 3 5 8
Suicide 10 1
103 97 200
Deaths under five
years 26 27 53
Still-born - 8 13 21
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 23
mortuarj Report for April, 1902.
Towns
AND RePORTEBS.
24 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
County Superintendents of Health.
Alamance Dr. H. R. Moore.
Alexander Dr. C. J. Carson.
Alleghany Dr. B. C. Waddell.
Anson Dr. J. H. Bennett.
Ashe Dr. J. W. Colvard.
Beaufort Dr. Jno. G. Blount.
Bertie Dr. H. V. Dunstan.
Bladen Dr. L. B. Evans.
Brunswick Dr. J. A. McNeill.
Buncombe Dr. E. B. Glenn.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. A. A. Kent.
Camden Dr. J. L. Lister.
Carteret Dr. F. M. Clark.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. H. T. Chapin
Cherokee Dr. J. W. Patton.
Chowan Dr. T. J. Hoskins.
Clay Dr. J. 0. Nichols.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr. N. H. Street.
Cumberland Dr. Jno. D. McRae.
Currituck Dr. H. M. Shaw.
Dare .Dr. AV. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James McGuire.
Duplin Dr. O. F. Smith.
Durham Dr. N. M. Johnson.
Edgecombe Dr. L. L. Staton.
Forsyth Dr. John Bynum.
Franklin Dr. E. S. Foster.
Gaston Di;. J. H. Jenkins.
Gates Dr. W. O. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. D. Booth.
Greene Dr. Joseph E. Grimsley.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. Green.
Harnett Dr. 0. L. Denning.
Haywood Dr. S. B. Medford.
Henderson Dr. .J. G. Waldrop.
Hertford Dr. J. H. Mitchell.
Hyde Dr. E. H. Jones.
Iredell Dr. Henry F. Long.
Jackson Dr. R. L. Davis.
Johnston Dr. L. D. Wharton.
Jones Dr. S. E. Koonce.
Lenoir Dr. C. L. Pridgen.
Lincoln Dr. T. F. Costner.
McDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke.
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. S. McLaughlin.
Mitchell.. Dr. V. R. Butt.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. D. C. Parris.
Pamlico
Pasquotank Dr. J. E. Wood.
Pender Dr. R. J. Williams.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing-house.
Polk Dr. Earle Grady.
Randolph Dr. S. A. Henley.
Richmond Dr. Wm. P. S. Webb.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford Dr. T. B. Twitty.
Sampson Dr. R. E. Lee.
Scotland Dr. A. W. Hamer.
Stanly Dr. V. A. Whitley.
Stokes Dr. W. V. McCanlesa.
Surry Dr. John R. Woltz.
Swain Dr. J. A. Cooper.
Transylvania Dr. C. W. Hunt.
Tyrrell
Union Dr. John M. Blair.
Vance Dr. Goode Cheatham.
Wake Dr. J. J. L. McCullers.
Warren Dr. A. S. Pendleton.
Washington Dr. W. H. Ward.
Watauga Dr. T. C. Blackburn.
Wayne Dr. Williams Spicer.
Wilkes Dr. W. P. Horton.
Wilson Dr. W. S. Anderson.
Yadkin Dr. M. A. Royall.
Yancey Dr. J. L. Ray.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 25
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board.
Have any of the following diseases occurred in your practice during the month
just closed. If so, state number of cases.
Whooping-cough Typhoid Fever
Measles Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever Cerebro-spinal Meningitis-
What have been the prevailing diseases in your practice?
Has any epidemic occurred among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks:
M. D.
190 — N. C.
^TTX^T^JEITXI^T
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G. Thomas, AI. D., Pres., Wilmington.
S. Westray Battle, M. D...Asheville.
Henry W. Lewis, M. D Jackson.
J. L. Nicholson, M. D Richlands.
W. P. IvEY, M. D Lenoir.
Francis Duffy, M. D New Bern.
W. H. Whitehead, M. D Rocky Mt.
J. L. Ludlow, C. E "Winston.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XVII. JUNE, 1902. No. 3.
Aiiunal Meeting of the State Board
of Health.
The annual meeting of the Board was
held at Wrightsville on June 11th, Drs.
Thomas, Ivey, Duffy, Whitehead Nichol-son
and R. H. Lewis being present.
The rules and regulations for the trans-portation
of the dead, as amended by the
Conference of State and Provincial
Boards of Health of North America at its
meeting at Niagara Falls in September,
1901, were adopted, and the Secretary
was ordered to have the same printed for
distribution to the transportation com-panies
and to the embalmers and imder-takers
of the State.
The short term of Dr. R. H. Lewis as a
member of the State Board of Embalm-ing
having expired, he was re-elected for
the full term, as the law requires.
Committees of two were appointed to
complete the inspection of the public in-stitutions
of the State.
A general inspection of all the public
water supplies of the State by the Engi-neer
of the Board was ordered.
The Secretary of the coEamittee ap-pointed
to revise the Instructions for
Quarantine and Disinfection submitted
their report, which was approved and
adopted.
Tuberculosis was discussed and sugges-tions
made with a view to a more active
fight against that dread disease.
The Treasurer submitted his report,
which was audited and found correct.
The conjoint session with the State
Medical Society was held as usual on
\^'edllesday of the meeting, the 12th.
President Thomas on taking the chair
made a short but excellent address, devot-ing
himself chiefly to the best method of
abating one of the greatest menaces to
tlie public health—the incompetent phy-sician.
In order to eliminate the per-sonal
element, he suggested that all in-
28 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
fcrmation necessary to conviction of il-legal
practitioners be furnished by those
coming into its possession to the Secre-tary
of the Board, who would then in
his official capacity bring the matter to
the attention of the Solicitor of the dis-trict
in which the violator of the law re-sides.
Subsequently this request was
made, and we trust it will bring forth
fruit. There are comparatively few il-legal
practitioners in the State, but one
is too many.
The Secretary of the Board submitted
his annual report, which will be found
below.
Dr. Tait Butler, the new State Veteri-narian,
being present by invitation of the
Board, was offered the privilege of the
floor and invited to participate in the dis-cussions.
He made a veiy favorable im-pression
by an excellent talk on bovine
tuberculosis, and called upon the medical
men present to use their influence to
l)uikl up a public opinion in support of
its regulation by the State, rightly hold-ing
that legislation would be of no avail
unless backed up by public opinion.
ANXUAL REPORT OF THE SECRETARY OF THE
NORTH CAROLIXA BOARD OF HEALTH.
Read at the Conjoint Session of the Board with
the State Medical Society at Wrightsville, N. C,
.January 12, 1902.
The work of the Board during the past
year has been chiefly routine in character,
but none the less useful on that account,
we hope. Since the more important
items have been pre^nously published in
the Bulletin, which is mailed every
month to every physician in the State,
and since a full report in detail for the
years 1901-1902 will be made to the next
Legislature, which meets early in Jan-uarv,
1903, it is unnecessary and inad-visable
to take up the limited time at
our disposal by a report of that char-acter
on this occasion. I will therefore
confine myself to a statement in a general
way of the more important work. This
is mainly included under sewerage inves-tigations,
inspections of some of the
State's institutions, bacteriological work,
the organization of the State Board of
Embalming and efforts to control small-pox.
Seicerage.—At the request of the city
Board of Health of \^ ilmington an in-vestigation
of the method of sewering
that city proposed by the \Yilmington
Sewer Company was made by Colonel
Shaffer, the Engineer of the Board at
that time, and recommendations made by
the committee appointed by the President
of the Board. The result was a modifica-tion
of the plans in accordance with the
suggestions made.
In compliance with an act of the
Legislature referring the settlement of
a controversy between the municipal au-thorities
of Blowing Rock and the two
leading hotels of that summer resort a
committee of the Board investigated and
settled the matter.
Inspections of State Institutions.—The
State Hospital and the School for the
Deaf and Dumb at Morganton were in-spected
and found in excellent condition.
By request of the proprietors, the pri-vate
sanatorium known as Broadoaks,
more especially its water supply, was
also made. The other State institutions
will receive their usual biennial inspec-tion
before the meeting of the next Gen-eral
Assembly.
Biological Laboratory.—As stated in
my last report at Durham the State
Board of Agriculture at its meeting in
December, 1900, at our request agreed to
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 29
have certain bacteriological work done for
the Board in its laboratory. At first
this was limited to examinations of sus-pected
drinking waters, but was later ex-tended
so as to include specimens from
diphtheria cases, blood in doubtful cases
of fever, and sputum. This generous ac-tion
on the part of the Board of Agricul-ture,
I am sorry to say, has not been
appreciated, or at least availed of, by the
profession, as was hoped and expected.
According to the report of the Biologist
of the Department, Mr. McCarthy, the
total number of biological analyses made
in the past six months was 141—35 pa-thological,
mostly of sputum, 48 of drink-ing
water and 58 of milk—a total of 83,
or an average of only 14 a month. When
we consider the fact that there are about
1,500 physicians in the State, it will be
seen that less than one per cent, take ad-vantage
of the valuable privilege offered.
The Board of Agriculture can hardly be
expected to do this work for us in-definitely,
and the time will come when
we must appeal to the Legislature for an
appropriation for it. The way to ob-tain
this is to show conclusively the value
and importance to the people of the work,
and the extent to which the laboratory
is pati'onized would be an index of the
opinion of ^the medical profession as to
its value. It is to be hoped, therefore,
that our physicians will avail themselves
more freely of these opportunities. It is
interesting to note that only one sample
of milk was found infected with the tu-bercle
bacillus and furtlier investiga-tion
showed that to have been accidental.
Board of Embalming.—The General As-sembly
of 1901 passed an act creating
the State Board of Embalming, consist-ing
of five (5) members, three from the
State Board of Health and two practical
embalmers, all to be elected by the Board
of Health. At the last annual meeting,
in compliance with the act, Drs. Battle,
Duffy and R. H. Lewis of the Board
and Messrs. J. M. Harry and H. W.
Simpson, practical embalmers, were
elected. The Board of Embalming thus
created organized on July 5, 1901, by
electing Mr. J. W. Harry of Charlotte,
President, and Mr. H. W. Simpson, of
New Bern, Secretary and Treasurer.
Since that time three meetings have been
held for examination of applicants for
license to practise embalming and sixty-three
licenses have been granted. This
action put us abreast on this line of the
most progressive and advanced boards of
Ilea 1th of the country. The importance
of having this Mork in cases of infec-tious
diseases done by one competent
not only to embalm but to properly dis-infect
the room and effects is self-evident.
In order to impress upon the undertakers
of the State the importance of thorough
disinfection and to set forth clearly
for their benefit the best methods, I read
a paper entitled "Tlie Embalmer in his
Relation to Infectious Diseases" at the
annual meeting last month of the State
Funeral Directors and Embalmers' As-sociation,
which seemed to be appreciated,
and which I hope will be productive of
good. It was printed in the Bclletin
for May, as you may have seen.
Small-pox.—As was anticipated and
predicted, small-pox has continued to pre-vail
in the State. Owing to the fact
tliat no small-pox was reported from \^'il-son
county from May 1, 1901, to Jan-uary
1, 1902, the Superintendent of
Health considering the eruptive disease
widely prevalent in tlie county to be
chicken-pox, it is impossible to give an
accurate statement for the whole State.
30 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Omitting Wilson county for the pres.ent,
and confining ourselves to the other
ninety-six counties, the totals are as fol-lows:
Xuniber of counties infected (in-cluding
AVilson), 5.5: number of cases,
whites 616, colored 1,196, total 1,812;
mmiber of deaths, whites 21 or 3.41 per
cent., colored 27 or 2.28 per cent., total 48
or 2.59 per cent. The figures for the pre-ceding
year are: Cases, white 530, col-ored
1,415, total 1,945; deaths, white 15
or 2.83 per cent., colored 23 or 1.63 per
cent., total 36 or 1.95 per cent. From
this it appears that the death-rate dur-ing
the past year has been slightly higher
than the year before, but not so high as
the year preceding that, when it was
4.78 for the whites, 1.44 for the colored.
The chief difficulty in the management
of the disease has been the same as hereto-fore—
mistaken diagnosis as chicken-po.x;.
This was the trouble in Wilson county,
the authorities not admitting it to be
small-pox until an expert from i,he Ma-rine
Hospital Service, kindly sent at our
request by Surgeon-General Wyman early
in January, declared it to be unquestion-ably
small-pox; and representatives from
contiguous comities at a meeting held at
Rocky Mount on the 14th of January
threatened to quarantine against Wilson
unless the precautions proper against
small-pox were immediately taken by
that county. From that time the dis-ease
was reported to me regularly as
$mall-pox. the total number of cases, not
clas.sified as to color, being 333, with 6
deaths from January 1st to J\Iay 1. Prior
to this period the Chairman of the
County Sanitary Committee of Wilson
told me in a personal interview that in
his opinion there had been up to the time
of our conversation 1,500 cases. So it is
safe to say that, including the 333 cases
reported after Januaiy 1st, there were
during the past small- pox year between
1,500 and 2.000 cases in that one county.
Adding this to the 1,817 cases reported
from the rest of the State would make
between 3.000 and 3,500 cases, the
largest number ever occurring in the
State in the same length of time.
Three counties, Camden, Pamlico and
Tyrrell, failed to comply with the law
requiring the election of a superinten-dent
of health. An outbreak of small-pox
in Camden county last montli, however,
demonstrated the utter helplessness of
the authorities to control the disease,
and this fact, strongly re-enforced by the
excellent work of Inspector Tayloe,
l)rought about a prompt election of a
superintendent by the County Sanitary
Committee. So that now there are only
two counties in the State that are with-out
that important official. We hope
to secure action in these two counties
before we meet again.
Tlie two Small-pox Inspectors, Drs.
Tayloe and Harrill, have rendered good
service, though their services, owing to
previous experience with the disease on
the part of the local authorities, have
been less in demand than ' heretofore.
Their reports are appended, as is a
tabulated statement by counties of small-pox
in the State from May 1, 1901, to
May 1, 1902.
While nothing especially brilliant has
been accomplished during the past year,
the work of the Board, I think we can
claim, is more appreciated than ever be-fore.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 31
Review of Diseases for Slay, 190!4.
EIGIITY-XIXE COUNTIES REPORTING.
Ninety-five counties have Sni^erinten-dents
of Health.
Except in the case of tlie more conta-gious
and dangerous diseases the Super-intendent
has, as a rule, to rely upon his
own information alone, since few phy-sicians
can be induced to report "cases of
non-contagious diseases to him.
Where the number of cases is not given
or the prevalence of a disease otherwise
indicated, its mere presence in the county
is to be understood as reported.
For tlie month of May the following
diseases have been rejjorted from the
comities named:
Measles.—Anson, many cases; Beau-fort.
10; Bladen, 50; Brunswick, many;
Bmke, 3; Cabarrus, 12; Camden, 6; Cas-well,
several; Chatham, many; Cumber-land,
a few ; Durham, a few ; Forsyth, a
great many; Granville, 8; Guilford, 7;
Harnett, many; Johnston, many; Jones,
epidemic; McDowell, 1; Onslow, 6; Per-son,
a few; Randolph, a few; Rocking-ham,
many; Scotland, a few; Swain, 2;
Union, 10; Wake, 15; Wilkes, Yadkin,
1—28 counties.
WHOopiNG-coroii.—Alamance, 35; Beau-fort,
3; Bladen, 12; Cabarrus, 21; Cas-well,
several; Craven, 8; Cumberland, a
few; -Davidson; Durham, a few; Forsyth,
a few; Granville, 4; Guilford, 3; Har-nett,
many; Hertford, 9; Johnston,
many; IsTortbampton, many; Robeson,
several; Sampson, many: Swain, (i;
Union, 0; Wake, 1; Wasliington, 8—22
counties.
Sc.\RLET Fever.—Davidson, 1 ; Davie,
6; Haywood, 1; Rowan, 1.
Diphtheria.—New Hanover, 3.
TYPiunn Fever.—Ashe, 1 ; Bladen, 3
;
Caldwell, 1; Catawba, 1; Chatham, 1;
Chowan, 1; Clay, 3; Cleveland, a few;
Craven, 2; Graham, 1; Granville, 4; Har-nett,
a few; Johnston, 3; McDowell, 1;
Xash, 4; New Hanover, 3; Northampton,
o ; Onslow, 1 ; Pasquotank, 1 ; Richmond,
2; Rockingham, a few; Rowan, 3; Ruth-erford,
3; Stanly, 2; Stokes, 2; Vance,
a few; Wake, 3; Washington, 2; Wayne,
several—29 counties.
^Malarial Fever.—Bertie, Caswell, in
nearly all parts; Columbus, a few; Cur-rituck;
Franklin; Gates; Greene, in all
parts; H^tford; Lenoir; Onslow; Pen-der,
a few ; Sampson, in nearly all parts
;
Wayne—13 counties.
Malarial Fever, Pekxicious.—Hert-ford,
2.
Malarial Fever, Hemorrhagic.—
Franklin, 1.
Bowel Disease.s.—Alamance. Anson,
Bladen, general ; Brunswick, in most
parts; Burke, a few; Camden; Catawba;
Cleveland; Columbus, a few; Currituck;
Davidson, general; Gaston; Gates, general;
Granville; Greene; Guilford; Hertford;
Iredell, general; Jackson, a few; Lenoir,
many; Lincoln; Martin, New Hanover,
Northampton, general; Onslow; Orange,
many; Pasquotank; Pender, Pitt, Ran-dolph,
Richmond, general; Robeson;
Sampson, in nearly all parts; Scotland,
Union, Vance, Wake, general; Warren;
Washington, general; Wayne—40 coun-ties.
MiMPS.—Caltarrus. in all parts; Cas-well,
ill nearly all ])aits; Cleveland, a
few; .lolmstoii : Person, a few: Wa-tauga—
counties.
Roseola.—Henderson, many cases.
Small-pox.—Beaufort, 1; Cabarrus,
2; Camden, 4; Carteret, 1; Catawba, 20,
"confined to negroes near Catawba—no
new cases reported for several days
—
32 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
have vaccinated all exposed persons—it
is a light form"; Forsyth, 6; Gaston, 50
or 60, "at McAdenville—compulsory vac-cination
has been rigidly carried out and
there is no apprehension of a further out-break";
Haywood, 10; Johnston, 3; Lin-coln,
1 ; Mecklenburg, 08 ; New Hanover,
1 ; Rockingham, 29 ; Rowan, 8 ; Stanly, 3 ;
Surry, 20, "on May 11 I went to Mt.
Airy and found five cases which were
quarantined—since then 15 more cases
have developed, all in mild form except
1 complicated with pneumonia, 5 white,
15 colored—I got Dr. J. M. HoUingsworth
to take charge of them and he has vac-cinated
40 in the families concerned
—
the authorities have rendered all the aid
possible"; Union, 25; Wilson, 4; Yadkin,
2—19 counties.
Cholera, in Chickens.—Orange.
Cholera, in Hogs.—Chowan, Hert-ford
and Robeson.
An epidemic of some kind among
horses in Pasquotank.
No diseases of importance reported
from Alexander, Buncombe, Dare, Duplin,
Edgecombe, Hyde, Macon, Madison, Per-quimans,
Polk, Transylvania and Yan-cey.
No reports received from Alleghany,
Cherokee, Halifax, Mitchell, Montgom-ery
and Moore.
Snniniary of Alortnary Reports for
May, 1903.
(twenty-eight towns).
Aggregate popula- White. CoVd. Total
tion 91,160 62,740 153,900
Aggregate deaths .
.
147 164 311
Representing tem-porary
annual
death rate per
1,000 19.3 31.4 24.2
Causes of Death.
Typhoid fever 112 Malarial fever 5 3 8
Diphtheria 10 1
Whooping-cough... 3 3
Measles 10 1
Pneumonia 7 20 27
Consumption 15 19 34
Brain diseases 3 4 7
Heart diseases 8 14 22
Neurotic diseases... 8 6 14
Diarrhceal diseases 26 23 49
All other diseases.. 65 70 135
Accident 3 2 5
Suicide 10 1
Violence 2 2
147 164 311
Deaths under five
years 55 68 123
Still-born - 8 12 20
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 33
Itlortuarj Report for 9Iaj, 1902.
Towns
AND RePOBTEBS.
AshevUle f
Dr. C. V. Reynolds, t
Cliarlotte /
Dr. F. O. Hawley. \
Dnrliain f
Dr. N. M. Johnson. \
Edenton f
Dr. T. J. Hoskins. t
Faj'etteville f
Dr. John D. MacRae. (
Ooldsboro <
Geo. E. Hood, Mayor. (
Greeiij^boro 5
Jno. S. Michaux, C. C. J
Heudersou f
Dr. F. R. Harris. 1
Lianrliibnrg f
Dr. A. VV. Earner. \
Lenoir f
• Dr. A. A. Kent. \
liexin^ton (
J. H. Moyer, Mayor. (
Marloii (
Dr. B. A. Cheek. \
Mouroe f
Dr. J. M. Blair. t
Mt. Olive J
Dr. C. S. Maxwell. \
Oxford (
Dr. S. D. Booth. \
Raleigh (
T. P.^5ale, ClerkB. H.'i ,
Reldsvllle f I
Jas. T. Smith, Cy. CI. 1
Rocklugtiam f i
Dr. Wm. P. S. Webb. )
j Rocky Mount f
Dr.G.L.Wimberley.Jrt
!
Salem ) I
F.E. Keehln,Supt. H. )
[ Salisbury f
Dr. W. W. xMcKenzie. \
Sontbport (
Dr. D. I. Watson. \
Tarboro f
Dr. L. L. Staton. (
I
AVasliln^^on (
Dr. Jno. G. Blount. \,
WaynesvUle i i
T. Stringtield, Mayor. ] Weldon (
J. T. Gooch, Mayor. ) WUmln^ou f
Dr. Cha.s. T. Harper. \
Wilson j
L^r. W. S. Anderson. |
Popula-tion.
CQ
10,0001
4,800,
11,000'
7,200
8,000
5,000
960
2,090
2,500|
2,300}
3,400;
2,600!
6,100'
4.000
2,100]
l,700j
800'
600
1,200
300
800
500
800;
350
1,850
!
600
400
300
1,200
1,100
8,000
5,800,
2,900
1,300
1,500
500
1,600
1,5001
3,300
350
3,900
2,500
900,
500;
2,000;
500
2,400
1
2,600|
1,000|
30O
700
750 1
10,000'
11,000
1,850
1,700
Temporabt
Annual
Death Rate
PEB 1,000,
EQ
13,000
3,050
4,800
6,000
10,100
3,800
1,400
1,500
1,300
1,150
2,450
700
2,300
13,800
4,2001
I
2,000i
3,100
3,650:
6,400
1,400[
2,500
1
5,000;
1,300
1,450|
21,000'
3,550
96
35.0
25.1
36.7
21.0
28 8
00
0.0
0.0
31.3
28.2
36.9
59
45.0
51.4
20.0
30.0
40.0
0.0
0.0
15.0
0.0
0.0
34 4
6.5
0.0
0.0
40.0
0.0
136
25.5
37.2
8.3
18.4
48.0
0.0
0.0
0.0
18.2
0.0
21.5
24.0
13.3
48.0
0.0
24.0
15.0
18.5
36
0.0
17.1
48.0
31.2
447
32.4
423
1,7.8
29.7
22.1
0.0
15.0
32.0
21.4
34.7
34.3
0.0
9.2
10.4
4.9
17.1
20.9
30.4
11.4
36.0
0.0
16.4
22.5
25.7
48
16.8
27.7
33.1
38.3
37.2
2 * « S -S
5 J = =
34 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
SMALL-POX IN NORTH CAROLINA, MAY 1, 1901, TO MAY 1, 1902.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 35
County Superintendents of Healtb.
Alamance Dr. H. R. Moore.
Alexander Dr. C. J. Carson.
Alleghany Dr. B. C. Waddell.
Anson Dr. J. H. Bennett.
Ashe Dr. J. W. Colvard.
Beaufort Dr. Jno. G. Blount.
Bertie Dr. H. V. Dunstan.
Bladen Dr. L. B. Evans.
Brunswick Dr. J. A. McNeill.
Buncombe Dr. E. B. Glenn.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. A. A. Kent.
Camden Dr. J. L. Lister.
Carteret Dr. F. M. Clark.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. H. T. Chapin
Cherokee Dr. J. W. Patton.
Chowan Dr. T. J. Hoskins.
Clay Dr. J. 0. Nichols.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr. N. H. Street.
Cumberland Dr. Jno. D. McRae.
Currituck Dr. H. M. Shaw.
Dare Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James McGuire.
Duplin. Dr. O. F. Smith.
Durham Dr. N. M. Johnson.
Edgecombe Dr. L. L. Staton.
Forsyth Dr. John Bynum.
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. O. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. D. Booth.
Greene Dr. Joseph E. Grimsley.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. Green.
Harnett Dr. O. L. Denning.
Haywood Dr. S. B. Medford.
Henderson Dr. J. G. Waldrop.
Hertford Dr. J. H. Mitchell.
Hyde Dr. E. H. Jones.
Iredell Dr. Henry F. Long.
Jackson Dr. R. L. Davis.
Johnston Dr. L. D. Wharton.
Jones Dr. S. E. Koonce.
Lenoir Dr. C. L. Pridgen.
Lincoln Dr. T. F. Costner.
McDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke.
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. S. McLaughlin.
Mitchell Dr. T. R. Butt.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. D. C. Parris.
Pamlico
Pasquotank Dr. J. E. Wood.
Pender Dr. R. J. Williams.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing-house.
Polk Dr. Earle Grady.
Randolph Dr. S. A. Henley.
Richmond Dr. Wm. P. S. Webb.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford Dr. T. B. Twitty.
Sampson Dr. R. E. Lee.
Scotland Dr. A. W. Hamer.
Stanly Dr. V. A. Whitley.
Stokes Dr. W. V. McCanless.
Surry Dr. John R. Woltz.
Swain Dr. J. A. Cooper.
Transvlvania Dr. C. W. Hunt.
Tyrrell
Union Dr. John M. Blair.
Vance Dr. Goode Cheatham.
Wake Dr. J. J. L. McCullera.
Warren Dr. A. S. Pendleton.
Washington Dr. W. H. Ward.
Watauga Dr. T. C. Blackburn.
Wayne Dr. Williams Spicer.
Wilkes Dr. W. P. Horton.
Wilson Dr. W. S. Anderson.
Yadkin Dr. M. A. Royall.
Yancey Dr. J. L. Ray.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 37
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
coupty on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board.
Have any of the following diseases occurred in your practice during the month
just closed. If so, state number of cases.
Whooping-cough Typhoid Fever
Measles Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever Cerebro-spinal Meningitis
What have been the prevailing diseases in your practice?
Has any epidemic occurred among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks:
M. D.
190— N. C.
:B"cri-.ni.:H]i:iisr
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G. Thomas, M. D. , Pres., Wilmington.
S. Westray Battle, M. D...Asheville.
Hexry W. Lewis, M. D Jackson.
J. L. jSTicholsox, M. D Richlands.
W. P. Ivey, M. D Lenoir.
Francis Duffy, M. D New Bern.
W. H. Whitehead, M. D Rocky Mt.
J. L. Ludlow, C. E Winston.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XVII. JULY, 1902. No. 4.
Biological Analyses of AVater and
PatUological Material.
Tliere have been so many irregulari-ties
and imperfections in the taking and
shipping of samples for biological analy-ses
that we feel constrained to publish
again the instructions, which we beg our
medical readers to consider carefully and
observe exactly. The following is the new
circular of information issued from the
laboratory of the Department of Agri-culture
:
The value of biological analyses in de-termining
obscure diagnoses, and in test-ing
the purity of water supplies is so
generally recognized by the medical pro-fession
everywliere that all progressive
States now make some provision for hav-ing
such work done at the public cost.
The North Carolina Board of Health, by
courtesy of the State Department of Ag-riculture,
has been able to offer such as-sistance
to the medical men of the State
since lOni.
The sanitary work done in the De-partment's
Biological Laboratory is of
two classes, viz.
:
1. Analyses of drinking waters.
2. Examination of pathological mat-ter.
In consideration of the extreme deli-cacy
of the biological and microscopic
test and the ease with which samples
I)ecome contaminated, it is absolutely
necessary to formulate certain rules for
governing the taking and sending of sani-l)
les. The State Board of Health has
])ublished such rules, and a copy of the
rules is always sent out with every sam-pling
outfit. As the analytical work is
very expensive and laborious, and tlie re-sults
to be of real value must assume
that all necessary precautions have been
taken, it is only reasonable to expect
that physicians shall i^erform their part.
As a matter of fact many of the samples
sent to the laboratory by physicians and
health officers are taken with little or
no regard to the rules. Especially is
40 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
this the case with blood samples. Sam-ples
of sputum are frequently received
in cases sent out for diphtheritic ex-udates.
The rules of the Board of
Health and of the U. S. Postoffice pre-scribe
that sputum samples must invari-ably
be sent only in double mailing cases.
The sending of such dangerous matter in
single cases renders the sender subject to
a heavy fine by the postal laws. The
Board of Health has provided proper
cases for such samples, and there is no
excuse for sending them otherwise.
In regard to samples of drinking wat-ers,
the laboratory frequently receives
samples put up in old medicine bottles
and corked Avith second-hand corks.
Such samples are wholly worthless for a
l)iological analysis, and must therefore
l)e discarded.
The following is a synopsis of the
rules governing the biological analyses
done by the Board of Health. They
should be carefully read and kept in
mind by every physician who expects to
send such samples:
To secure a biological analysis of water
by the State, make application to the
Secretary of State Board of Health at
Ealeigh. The State Board of Health has
adopted the following rule: "The person
desiring a bacteriological examination of
drinking water must first apply to the
Superintendent of Health of his county
or the medical health officer of his city
or town if it have one, or to his family
physician. This officer or physician will,
if in his opinion there be just cause to
suspect said drinking water as the
source of disease, write to the Secretary
of the State Board of Health, giving his
reasons for such suspicion. Should these
lie satisfactory to the latter, he will ap-prove
the application and transmit the
same to the State Biologist, wlio will
forward this permit to said officer or
physician. The sample must be taken
and packed by a physician, in strict ac-cordance
with the given directions." J\'o
deviation from this rule.
Samples for biological analysis must
in every case be sent in bottles sterilized
and prepared in the laboratory of the
Department of Agriculture. Xo sample
sent without previous application for
permit, bottle and descriptive blank, as
specified in paragraph Xo. 1, will be ac-cepted
or analyzed.
A limited number of samples of path-ological
material willl be examined for
physicians by the Biologist. Applica-tion
for such examination must be en-dorsed
by the Secretary of the State
Board of Health. Application from
country physicians and County Su-perintendents
of Health will receive
preference. WorJc of this kind cannot he
done for hospitals or sanitariums.
Pathological material will not be exam-ined
unless there is clinical reasons for
suspecting the presence of one of the
microbes named below.
All samples must be taken by a physi-cian,
according to the directions furn-ished
and must be fully described and
certified on form sent.
All transportation charges on samples
and containers must he paid by the
sender.
For the present only following-named
material can be accepted to be examined
for the microbes specified:
(a) Milk and sputum to be examined
for Bacillus Tuberculosis.
(b) Diptheritie exudates to be exam-ined
for Bacillus diphtheriae.
(c) Blood to be tested for Bacillus
Typhosus.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 41
(d) Blood to be examined for Plasmo-dia
of malaria and B. anthracis.
In eases of suspected diphtheria or
fevers of doubtful character, application
may be made direct to the State Biologist,
Mr. Gerald McCarthy, Department of Ag-riculture,
Raleigh; or in those counties
having sampling outfits and instruction
blanks on deposit, such samples (diph-theria
and blood) may be sent without
previous application.
Malaria and Typhoid.
It has been conclusively demonstrated
that the poison known as malaria is not
"bad air" but a blood parasite, the plas-inodiuDi
Dialariac which feeds upon and
develops in the red corpuscles of the
blood, and that it is conveyed by a par-ticular
genus of mosquitoes named An-opheles—
and probably in no other way.
This demonstration shows malarial fever
to be a preventable disease. A person
can reside in the most malarious region
with perfect . impunity if he can protect
himself against the sting of the variety
of mosquitoes mentioned which have pre-viously
stung another person having the
fever, thereby infecting themselves with
the germs of the disease. This can be
done in three ways—by destroying the
mosquitoes and preventing their breed-ing,
by protection against them by
screens, etc., and by preventing their
stinging persons sick of malarial fever.
Either one of these methods if properly
carried out would be effective, but as
perfection cannot be hoped for, all three,
should be resorted to.
The next two months, August and Sep-tember,
constitute the season of the year
in which malarial fevers, and malarial
fevers of the most malignant type—aesti-vo-
autumnal or the old-fashioned "bil-ious
fever," pernicious and hemorrhagic
—:i re most prevalent with us. It is
therefore in order for our people living
in malarious sections to begin at once
and prosecute unremittingly a vigorous
warfare against mosquitoes.
Tlie typhoid fever season is already
well Ijegun, and we beg to call the atten-tion
of our readers to the fact that the
spread of this disease can surely be pre-vented.
The source of the poison is in
the discharges of a patient. It is con-veyed
by drinking water or flies infected
therewith. The simplest and surest way
therefore to destroy the germs is to
iiiuiicdiately and thoroughli/ disinfect all
discharges from the bowels and kidneys,
and then bury them not less than 150
feet from any well or sjjring. As the
germs are also found in the discharges
of convalescents and in the preliminary
stages of the disease surface privies
should always be carefully looked after.
As bearing on the above, we take pleas-ure
in printing below the excellent
"Farmers' Bulletin No. 155" of the U. 8.
Department of Agriculture, by Dr. L. 0.
Howard, Entomologist of the Depart-ment,
omitting, much to our regret, the
illustrations for lack of the plates; and
the very interesting speculations of Dr.
King on the effect of light in the pro-duction
of malarial fever.
HOW INSECTS AFFECT HEALTH IN
RURAL DISTRICTS.
INTRODUCTION.
ill very many parts of the country the
farming population has to contend with
at least two diseases which are prevent-able.
These are malaria and fyi)hoid
fever. Both of these diseases are trans-feired
or may be transferred by insects-malaria
by certain mosquitoes and ty-l)
hoid fever by the common house fly, or
certain other flies.
42 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
CITY AND COUNTRY CONDITIONS COMPARED.
While it is true that both malaria and
typhoid prevail in large cities, it is none
the less true that they may with a cer-tain
degree of accuracy be termed coun-try
diseases, that is to say, rather spe-cifically,
diseases of the farm and the
small village. Malaria, in fact, has been
called by medical men a country disease.
Swampy regions do not occur in cities,
or, at all events, only in the suburbs,
whereas they occur commonly in the
country. Open streams with side pools
of still water are found only in the
country, and it is in such small, still
pools, and in more or less permanent
but small accumulations of water, that
the malarial mosquito breeds. This mos-quito,
therefore, does not accommodate
itself well to city conditions, but it is
found almost everywhere in the country,
except possibly in veiy dry localities and
at certain high elevations. Even in dry
regions it sometimes abounds, especially
where there is a definite rainy season, or
where the land is irrigated. Irrigating
ditches are prolific breeding places for
mosquitoes, including the malarial kind.
Malaria in cities, as a rule, is found only
with persons who have contracted it in
the country or in the suburbs, although
with some cities having marshy places
on their borders a malarial belt may
exists, the extent of which depends upon
the direction and force of the prevailing
summer breezes, especially the night
breezes. For example, such a condition
as this accounts for the prevalence of
malaria in certain portions of the city of
Washington before the reclamation of the
Potomac Flats, which lie to the south of
the city, the prevailing night breezes of
the summer being southern.
SOURCE.S OF TYPHOID FEVER.
Cities well supplied with water from a
reservoir, especially a filter reservoir,
w hich jjossesses a modern sewage system,
and in which water-closets are universal,
derive typhoid fever only from the follow-ing
sources: Contaminated country milk,
the return of people in the autumn from
the less sanitary country, and lack of
care in the disposal of the discharges of
persons who have contracted typhoid
from either of the first two sources.
In the country, however, conditions
are different. Each country house or
each house in a small village has
its own water supply, usually in
the shape of a well; the cattle
get water from the streams; there are no
water-closets, and excreta are deposited
in the open or in box privies; drainage
from these box privies or from the open
deposits containing virulent typhoid
germs may enter the streams, be carried
for some distance and be taken into the
stomachs of cattle all along the course of
the stream, or the germs may be carried
by underground drainage directly into
the wells from which drinking water is
gained; or, exposed as these box privies
or open deposits are, certain flies may
alight upon the excrement and carry the
germs directly to the food supply of the
houses; or certain flies may breed in
this excrement and fly, fairly reeking
mth disease-bearingfilth, to the kitchens
and tables of nearby houses. When we
consider that active typhoid germs may
be given out for some time by persons
who have not developed typhoid fever
sufficiently so that it may be recognized,
and that they may also be given out for
some time after the patients have been
apparently cured of the disease, it is
perfectly obvious that in the country
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 43
the lack of care with wliich excreta are
deposited readily accounts for outbreaks
of typhoid fever from any of the causes
mentioned.
METHODS OF PROTECTION FROM TYPHOID
AND MALARIA.
Of course it will be said that the en-tire
water supply of a city may become
contaminated at or immediately above
its reservoir supply. This contamination
is from country sources and might be
obviated either in a general manner by
the establishment of a reservoir filtering
plant, or in a special manner by indi\ad-ual
householders by the constant and
thorough use of house filters. In cities
possessing a common water supply and
modern sanitary plumbing there is
no excuse for the presence of typhoid
in the household. Even the city water
must be filtered, which can be done by
the use of any of the cheap filters now
on the market [We beg to enter our pro-test
against the statement that "any of
the cheap filters now on the market"
will purify water infected with the germs
of typhoid fever. On the contrary it has
been shown that the ordinary domestic
filter, while taking out mechanical im-purities,
is a positive breeder of germs
—
is worse than useless. There are only
two or three such filters that will stop
bacteria even for a short time, and they
are not cheap.
—
Ed.]; the milk which is
drunk by children must be sterilized, and
the excreta of persons returning to the
city, after contracting typhoid fever in
the country, must be disinfected with the
utmost care. These three measures, sys-tematically
followed, will result in the
abolition of typhoid fever within the
city boundaries.
So much for cities. In the country the
matter is somewhat more difficult, and
immunity from malaria and typhoid de-pends
largely upon the individual house-holder.
Such immunity may be obtained,
but only as a result of intelligent care.
Let us briefly consider what the farmer
or the resident of a small village must do
to bring about protection.
The old idea that malaria is caused by
breathing the miasma of swamps has
been exploded. ]\Ialaria is contracted
only through the bites of mosquitoes of
the genus Anopheles. The cause of hu-man
malaria is the growth and deve-lopment
within the red blood cells of a
very minute parasitic organism belong-ing
to the lowest group of the animal
kingdom—the group Protozoa, or one-celled
animals, which includes those
minute creatures known as Amcebas and
others, which live in the water or in
damp sands or moss, or inside the bodies
of other animals as parasities. This
parasite reproduces in the body by sub-dividing,
eventually bursting the red
blood cells and entering the blood serum
as a mass of spores. Broadly speak-ing,
when the blood of a human being
is sucked into the stomach of a mos-quito
of the genus Anopheles the ma-laria
parasite undergoes a se.xual de-velopment
and gives birth to a large
number of minute, spindle-shaped cells,
known as blasts, which enter the salivary
glands of the insect and are ejected with
the poison into the system of the next
person bitten by the mosquito. If this
persons happens to be nonmalarious the
malaria has thus entered his system and
malarial symptoms result.
So far as present knowledge goes,
this is the only way in which people be-come
malarious. In order to avoid this
result it is necessary to avoid the bites of
malarial mosquitoes, and it therefore be-
44 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
comes important to know the diiferences
between the malarial and the more harm-less
mosquitoes, and the conditions under
which the malarial forms breed.
Malaria-hearing mosquitoes.—There
are very many mosquitoes which have not
been yet proven to carry any disease.
In fact, the majority of mosquitoes are
supposed to be harmless except for the
irritation caused by their punctures. The
commonest of all forms belong to the
genus Culex. These include the mosqui-toes
most commonly breeding in rain-water
barrels and chance transient pools.
It will be noticed that Culex has clear
wings, while Anopheles has wings which
are more or less spotted. It will be
noticed further that while the palpi
(which are the projections either side
of the beak) are very short in Culex,
they are long—nearly as long as the
beak—in Anopheles. Further, it has
been observed that when Culex is rest-ing
upon a wall it appears more or less
humpbacked, that is to say, the head and
the beak are not in the same plane with
the body and wings, but project at an
angle toward the surface of the wall, the
body and wings being parallel with the
wall. With Anopheles, however, the head
and beak are in practically the same
plane with the body, and the body itself
is usually placed at an angle with the
wall, and especially when resting upon
a horizontal wall, such as the ceiling of
a room, the body of Anopheles is at a
very great angle with the surface. We
have in this country three species of the
malarial genus Anopheles, namely Ano-pheles
maculipennis, Anopheles puncti-pennis,
and Anopheles crucians. The two
former are found nearly all over the
country, but the last is a more Southern
species, although it has been found as
far north as the south shore of Long
Island.
As to the early stages, the eggs of Ano-pheles
may at once be distinguished from
the eggs of Culex, those of Culex being
laid in the raft- shaped mass on end and
those of Anopheles being laid singly upon
the surface of the water, always lying
upon their sides. The larvae of Culex,
commonly known as wigglers, are famil-iar
to almost every one, and are the com-mon
wigglers found in horse troughs and
rain-water barrels, which ^^^ggle around
in the water, returning at frequent inter-vals
to the surface to breathe, and at
the surface hanging with simply the tip
of the tail extruding, the rest of the
body being held below the surface at a
great angle. \Miat we have called the
tail"" is simply the breathing tube,
which, with the common Culex wigglers,
is long and more or less pointed. With
the malarial mosquitoes, however, the
wiggler, or larva, is of somewhat differ-ent
shape, and when resting at the stir-face,
which it does most of the time, it
lies with its body parallel with the sur-face,
and not hanging down, as does the
Culex wiggler.
Breeding places of malaria-bearing
mosquitoes.—The breeding places of the
harmless mosquitoes are more numerous
and more varied than the breeding places
of the malarial mosquitoes. Anopheles,
however, are fotmd under many divers
conditions. They are found, as stated,
in still side pools of small streams, in the
swampy pools at the margins of larger
ponds, in stagnant water in ditches, in
the beds of old canals, in the still water
at the sides of springs, and occasionally,
though rarely, in old horse troughs.
They are perhaps more frequently found
in smch situations as described when a
BULLETIN OF THE NORTH CAKOLINA BOARD OF HEALTH. 45
certain amount of green sciuu has ac-cumulatetl,
and it is upon the spores of
the water phints constituting this green
scum, as well as upon other very small
objects floating on the surface of the
water, that they principally feed.
Measures to be taken to prevent ma-laria.—
To prevent malaria mosquitoes
from breeding in a given vicinity, one
should be prepared to recognize their
larvae when they are seen, and to dis-tinguish
them from other mosquito
lars'se; then a most thorough search
for all possible breeding places should be
made within a radius of a mile. This
distance is mentioned, since it seems
rather definitely proven that the Ano-pheles
mosquitoes do not fly for great
distances. After the breeding places are
found they should be drained or filled in
\^-ith earth, or they shoud be rendered
uninhabitable to the Anopheles larvse
by covering the surface of the water with
a thin film of kerosene oil, or by intro-ducing
certain fish which feed upon the
larvae, such as top minnows, stickle-backs,
young sunfish, or goldfish.
Pending the result of such exterminat-ing
measures, all houses in malarious lo-calities
should be carefully screened to
prevent the entrance of mosquitoes.
After screening, thorough search should
be made in the house for mosquitoes
which liave already gained entrance.
Such as are found roosting upon the
walls shoud be captured by placing an
inverted vial over them, or they may be
stupefied by burning a small amount of
pyrethrum powder upon a tin-dish cover.
Persons wishing to avoid malaria should
not sit out of doors exposed to the bites
of mosquitoes at night. Persons having
malaria should be carefully screened at
night to prevent them from being bitten
by mosquitoes, which, becoming thus in-fected,
would become potential carriers of
the disease. Such patients, systemati-cally
treated with quinine, the dose being
always given at the beginning of the
chill, will soon be rid of the disease.
The time of the dose is important, and
the reasons for the time have been abund-antly
proven by the study of the life of
the parasite in the blood cells.
All of this advice is given only after
abundant demonstration of the eflacaey
of the methods. These measures have
been followed with success in the most
malarious localities in the world, and
with this knowledge there is no good
reason why an individual should contract
malaria in his own home, no matter how
much malaria exists around him.
Of course, however, there may be oc-casions
where it is almost impossible to
avoid contracting the disease. For ex-ample,
last October the writer was wait-ing
for a night train one evening in a
small Western town where there were
irrigating ditches near the station. In
these ditches malarial mosquitoes were
breeding profusely, and the insects
abounded in the station waiting room
and on the platform. Nothing but a
gauze covering would have kept them
away, and several bites were inflicted on
the hands and neck. Fortunately, none
of the individuals could have bitten a
malarial patient, as the disease was not
transmitted.
TYl'IIOID FEVER.
It is not the writer's intention to go
further into the causation of this disease
than he has already done in his intro-ductory
renuirks. He wishes, however,
to point out as forcibly as possible the
danger of its spread by insects and the
nietiiods of avoiding this danger.
46 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
House flies and breeding -places.—The
principal insect agent in this spread is
the common house fly, and this insect is
especially abundant in country houses in
the vicinity of stables in which horses
are kept. The reason for this is that
the preferretl food of the larva; of house
flies is horse manure. House flies breed
in incredible numbers in a manure pile
largely derived from horses. Twelve
hundred house flies, and perhaps more,
will issue from a pound of horse manure.
Ten days completes a generation of
house flies in the summer. The num-ber
of eggs laid by each female fly aver-ages
120. Thus, under favorable condi-tions,
the offspring of a single over-wintering
house fly may in the course of
a summer reach a figure almost beyond
belief. With an uncared-for pile of
horse manure in the vicinity of a house,
therefore, flies are sure to swarm. Their
number practically will he limited only
by breeding opportunities. They are at-tracted
to, and will lay their eggs in, hu-man
excrement. Under favorable condi-tions
ttiey will breed, to some extent, in
this excrement. They swarm in kitchens
and dining rooms where food supplies
are exposed. They are found commonly
in box privies, which sometimes are not
distant from the kitchens and dining
rooms. Tlierefore with an abundauco ot
flies, with a box pri\'y near by, or witli
excremental deposits in the neighbor
hood, and with a perhaps unsuspected or
not yet fully developed case of typhoid
in the immediate neighborhood, there is
no reason why, through the agency of con-taminated
flies alighting upon food sup-plies,
the disease should not be spread
to healthy individuals. That it is so
spread is not to be questioned. That
under the usual conditions of the army
concentration camps in the summer of
1898 it was so spread to a shocking ox-tent
has been demonstrated by the army
typhoid fever commission. And the rem-edy
is plain. It consists of two courses
of procedure: (1) Proper care of ex-creta;
(2) The destruction of flies.
Measures to he taken to prevent ty-phoid
ferer.—On many farms where in-telligent
people live the old-fashioned box
privy has been done away with, and there
has been substituted for it some form of
earth closet. Where a good earth closet
is in operation, and the inhabitants of
a farm appreciate the importace of using
no other, and where in case of illness
the excreta of patients are promptly dis-infected,
flies breeding in the neighbor-hood
will have practically no opportunity
to become contaminated with typhoid
germs, except in the unlikely event
(wliich future investigation may possi-bly
show) that other animals than man
are subject to this disease. The proper
maintenance of an earth closet will add
somewhat to the work of a farm, but
tliis extra work will pay in the long run.
^^'l^le it is true that a box inclosure, if
its contents are covered with lime every
thiee or four days, will answer the pur-pose,
a much better plan would be to use
a large metal vessel, the surface of the
contents being covered with earth after
each operation, and which may Be re-moved,
emptied and replaced. Care
should, of course, be taken to empty the
contents of the vessel in a pit construct-ed
in some well-chosen spot, from which
the drainage would not be dangerous.
With regard to the abolition of flies,
the best measures will again naturally in-volve
some trouble and expense. In a
thickly settled country it will become
necessary for some such measure to be
generally adopted in order to be perfectly
effective, but in an isolated farmhouse
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 47
the nuniber of house Hies may be greatly
reduced by individual work. All horse
manure accumulating in stables or barns
should be collected, if not daily, at least
once a week, and should be placed in
either a pit or vault or in a screened in-closure
like a closet at the side or end of
the stable. This closet should have an
outside door from which horse manure
can be shoveled when it is needed for
manuring purposes. Each day's or each
week's accumulations, after they are
shoveled into the closet or pit, should
be sprinkled over the surface with chlo-ride
of lime, and a barrel of this sub-stance
can conveniently be kept in the
closet. If this plan be adopted (and
these recommendations are the result of
practical experience ) . house flies will
have almost no chance to breed, and
their numbers will be so greatly reduced
that they will hardly be noticeable. Many
experiments have been made in the treat-ment
of manure piles in order to kill the
maggots of the house fly, and the chlo-ride-
of-lime treatment has been found to
be the cheapest and most efficacious.
It has been stated above that the
closet for the reception of maniu'e should
be made tight to prevent the entrance or
exit of flies. A window fitted with a
wire screen is not desirable, since the
corroding chloride fumes will ruin a wire
screen in a few days.
Fruit flies.—While extended investiga-tions
have shown that the common house
fly is the fly most to be feared in guard-ing
against typhoid, on account of the
fact that over 99 per cent, of the flies
found in kitchens and dining-rooms and
attracted to food supplies are house flies,
there are a few others which are attrac-ted
to and which may breed in human
excrement that also have to be guarded
against, and as these do not breed in
horse manure the treatment just describ-ed
will not be effective against them. The
care of human excrement, however, will
prevent the carriage of typhoid germs
even by these species. Tlie little fruit
flies of the genus Drosophila, which
breed in overripe or decaying fruit, are
the principal species in this category.
Therefore, fruit store-houses or fruit re-ceptacles
should be screened, and over-ripe
fruit should not be allowed to re-main
in dining rooms or kitchens for any
length of time.
OTHER UISEASES CARRIED BY INSECTS.
While in malaria and typhoii we have
the two principal diseases common to
the United States which may be con-
\ eyed by insects, the agency of these lit-tle
creatures in the transfer of disease
germs is much more widespread in warm
countries, and it is by no means confined
to human beings. In Egypt and in the
Fiji Islands there is a destructive eye
disease of human beings, the germs of
which are carried by the common house
lly. In our Southern States an eye dis-ease
knoAvn as pink-eye is carried by cer-tain
very minute flies of the genus Hijp-pelates.
In certain tropical countries a
disease known as filariasis, which some-what
resembles certain forms of leprosy,
is transferred among human beings by
certain mosquitoes. There is good rea-son
to suppose that the germs of the
bubonic plague may be transferred from
sick people to healthy people by the bites
of fleas. The so-called Texas fever of
cattle is unquestionably transferred by
the common cattle tick, and this was the
earliest of the clearly demonstrated cases
of the transfer of disease by insects. In
Africa a similar disease of cattle is
transferred by the bite of the famous
biting fly known as the tsetse fly. The
48 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
germs of the disease of cattle known as
anthrax are carried by gadflies, or horse
flies, and when these flies subsequently
bite human beings malignant pustules
may result, and other discoveries of
this nature are constantly being made.
Even the common bedbug is strongly
suspected in this connection.
YELLOW FEVER.
One of the most important of these
disease-transfer relations of insects
which has been demonstrated is the
recently proved carriage of yellow lover
by certain mosquitoes. The cause of
yellow fever has always been a mystery;
and indeed it is a mystery to-day in a
measure, since although undoubtedly a
disease of parasitic origin, the para-sitic
organism itself has not yet
been discovered. During the sum-mer
and autumn of 1900 and spring
and summer of 1901 the work of a com-mission
of surgeons of the United States
Army has demonstrated in Cuba be-yond
the slightest possible doubt that
yellow fever is not conveyed by infected
clothing of yellow-fever patients or by
.contact with such patients or by prox-imity
to them, but that it is conveyed
by the bite of a certain species of mos-quito
known as Stegomyia fasciata,
which abounds in regions where yellow
fever is possible. The bite of this mos-quito,
however, does not convey yellow
fever to a healthy person until twelve
days have elapsed from the time when
the same mosquito has lutten a person
suflfering with the disease. It follows
from this fact that by keeping yellow-fever
patients screened from the possi-bilities
of mosquito bites we can prevent
the yellow- fever mosquito from becoming
infected. It follows further that by pre-venting
healthy people from being bit-ten
by mosquitoes we can keep them free
from the disease even where infected mos-quitoes
exist. And it follows still fur-ther
that by the adoption of remedial
measures looking toward the destruction
in all stages of the yellow-fever mosquito
we may reduce to a minimum the possi-bilities
of the transfer of the disease.
After demonstrating the fact, the medi-cal
officers of the Army in Cuba have
put these measures into elfect, and the re-sults
have been most gratifying. The
health of Havana has constantly im-proved,
and at the date of jjresent writ-ing
the published statement has just
been made that during the month of
October, 1901, there was not a single
case of yellow fever in Havana, while Oc-tober
is usually the severest month for
that disease, and in fact during the past
ten years the average number of deaths
in the city during that month from yel-low
fever has been 66.27. This discov-ery,
and this practical demonstration of
its truth, it seems must soon change all
methods of quarantine in the United
States; and it seems certain that in the
future the Gulf cities will no longer
dread the disease or remain subject to
the great vital and economic loss to
which they have been subject from oc-casional
yellow-fever outbreaks during
past generations.
Siiuliglit and Malaria—Cure of Iiiter-inltteut
Fevers toy Darkness an«l
FlMorescent Llglit.
BY A. F. A. KING,' M. D., WASHINGTON, D. C.
Professor of Obstetrics, University of Vermont
Medical Department, etc.
It is now well established that ma-larial
fever is produced by a parasite
(the ijl(is,iiC(Jiv)ii inalariae, so-called),
wliirli feeds on and breeds in the red cor-
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 49
puscles of the blood; that this parasite
gets into the blood oy the bites'^of mos-quitoes
; that the fever paroxysms are
produced by the periodic sporulation of
successive groups of these parasites;
and, that generally, but not always, the
parasite is destroyed and tlie disease
cured by quinine.
During the leisure hours of my so-journ
in Burlington last summer, while
thinking over the idea that malarial
melanosis was a conservative process
—
a sort of ''protective coloring" to hide
man from the mosquito—as stated in
my paper on "Mosquitoes and Malaria,"
published in Popular Science Monthly
for September, 1883, and regarding the
whole process as a pigment disease, the
idea of color suggested light ; light sug-gested
darkness; with these the varia-tions
of day and night, and the diurnal
periodicity of malarial fever paroxysms,
inevitably led me to the suppofition that
sunlight nuist have something to do in
tlu' drama of this disease. The facts
that '"chills" do not occur at night in
tlie dark: and that people with black
skins are more or less exempt, encour-aged
the supposition. Following out
tliis idea. I have embodied the results in
lliree papers recently published in the
"American Journal of Medical Sciences"
for February and June, 190'2, and in the
"Washington Medical Annals," Vol. I,
No. 1. for IMarch, 1902.
A brief synopsis of those publications
is here presented for the Vermont Medi-cal
Monthly. The following propositions
were stated, viz.
:
1. The sporulation ot malarial para-sites
in the blood will be retarded, or
fail to take place at all, in continued
darkness. Other things being equal,
tliis s|i()riilation will be the more rapid
and i(;tnj)Iete in diicc) propnrlidn to the
intensity of the sunlight to which the
body may be exposed and the duration of
such exposure.
2. To prevent malarial fever (after
infection) protect the human body from
the light of the sun.
.3. To cure the disease, protect the
body from the light of the sun, or in
some other way prevent the parasites
from receiving this light.
The evidence in support of these state-ments
is as follows:
First. The accumulated experience
and observations of centuries, which
have been supposed to prove the agency
of solar heat in producing malarial
fever, should be really attributed to solar
liglit. Heat cannot warm the parasite
while floating in a bath of blood at 98.2
degrees. Light can enter a translucent
skin and act upon the plasmodium, aa
we shall see farther on, it does upon
other amoebae.
Second. Paroxysms of regular inter-mittent
fever will not, as a rule, occur
at night, or in the dark. Exceptionally
"chills" do occur at night; but often
they are chills of tuberculosis, or of
secondary syphilis, or of suppuration,
etc., etc., that have been mistaken for
ague chills. Again, it is possible that
artificial light or brilliant moonlight
may develop sporulation of the parasite
during the night.
Third. The relative liability and rela-tive
immunity of different races of men
to these fevers will depend, respectively,
upon the relative translucency or non-translucency
of their skin and of their
blood. Black
—
thoroughly black
—
races
are exempt. Jlany negroes suffer, be-cause
their skins are not impenetrable to
light. In passing electric light through
the external ears of over a hundred dark
negroo. iu W.isliinyf on. I oiilv found
50 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
three that were impenetrable to light.
These had never had ague.
Fourth. In places where malarial
fever prevails, the disease is increased
by bright, sunny weather, and lessened
by clouded skies. In other words, when
the light of the sun is veiled by rain
clouds and fogs, the parasites get less
sunlight and their sporulation is retard-ed.
Numerous instances given.
Fifth. It is an old popular tradition
that to prevent the occurrence of ague in
malarial regions, to forestall its re-cur-rence
when it has already occurred, it
is best to keep in tbe shade and avoid
sunlight. Popular traditions usually
conoe from experience and are worth con-sideration.
Centuries ago the native Af-ricans
believed that mosquitoes produced
fevers. They were right.
Sixth. In typical cases of ordinary
ague the disease is spontaneously cur-able,
without medicine, by keeping the
patient in the shade. Evidence pre-sented.
Seventh. The malarial parasite is a
naked amoeba. Experiment shows that
red light promotes the vital activity of
amoebse, while violet or purple light re-stricts
it. The color of the light diffused
through the blood is, of necessity, red
as any one can see by holding the hand
over a candle in a dark place. Harring-ton
& Learning (Am. Jl. Physiology,
Vol. Ill, Xo. 1, 1899, pp. 9-18) have de-monstrated
that the amoeba proteus
streams in the presence of red light and
ceases to stream in light from the violet
end of the spectrum. Enucleated amoebae
stream in red light and cease to stream
in violet or white light.
Now if we assume that the malarial
amoeba is of the same nature (which,
however, requires future demonstration)
it would explain the cure of malarial
fevers by methylene blue, by Prussian
blue, and by iodine, which last becomes in
the stomach purple iodide of starch.
But how about quinine? If this
theory of light be correct, and if it be
true that the parasite is destroyed in
the blood by light from the violet end
of the spectnnn, the curative action of
quinine should fall in line with this idea
in some way.
Does quinine possess any peculiar re-lation
with light that would furnish
a clue to its curative effect ? It does.
It is remarkably fluorescent ; it accentu-ates
the violet rays of the spectrum and
even renders the ultra-violet ones sus-ceptible
to human vision.
In support of this idea that it is
the quality of fluorescence which gives
quinine its curative value in malaria,
I find first, that other substances pos-sessing
blue fluorescence, like quinine,
notably esculinc from the bark of the
horse chestnut tree, and fraxine from the
bark of the European ash, are effective
antiperiodics in ague and have long been
used successfully for this purpose.
As to quinine itself, the experiments of
Drs. Rhoads and Pepper demonstrated
over thirty years ago, long before we
knew anything of the malarial parasite
or mosquito, that in malarial disease
the fluorescence of the blood is di-minished,
and that quinine restores the
fluorescence to its normal standard, and
pari passu with this increase of fluores-cence
the fever disappears and the pa-tient
gets well. (See Pennsylvania Hos-pital
Pveports for 1868, pp. 269-280.
See also. Philadelphia Medical Times,
Jan. 23. 187.5, p. 259 et seq.
It may be noted that the normal flu-orescence
of the blood was discovered by
Dr. Henry Bence .Jones in 1866 (see
Medical Times and Gazette, London, Au-
BULLETIN OF THE NORTH CAROLINA

library of
(EI|e llntDcrsity of Hortl] Carolina
C O L L K C TI O X OF
NORTH C A R O L I N I A X A
K X D O W E D BY
J O H X S P R U X T PI I L I.
of the class of 1889
This book must not
be token from the
Library building.
^
^f.\^
^^'^
s>
^^
9^'
V^
\^^x^^^
oV^^
sV
Form No. 471
IBTTIL.I^El'XIISr
OF THE
Morth Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G.Thomas, M.D.,Prcs,, Wilmington. \ W. P. Ivey, M. D Lenoir.
S. Westray Battle, M. D...Asheville. Francis Duffy, M. D New Bern.
Henry W. Lewis, M. D Jackson. { W. H. Whitehead, M. D Rocky Mt.
J. L. XiCHOLSOx, M. D Rich lands. , J. L. Ludlow, C. E Winston.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigli.
Vol. XVII. APRIL, 1902. No. 1.
Biological Examinations Once More.
Very few counties have availed them-selves
of our offer to deposit with the
Superintendent of Health apparatus for
mailing specimens in cases of suspected
diphtheria and of fevers upon the re-quest
of even one physician in the county.
This offer remains open. If desired we
will make a deposit with the medical
health officers of the cities and towns.
Promptness is .so all-important in
diphtheria that in those counties which
have no mailing cases on deposit physi-cians
should telegraph directly to the
Biologist, Mr. G. McCarthy, for mailing
cases. Application should also be made
directly to him in fever cases. For spu-tum
and water analyses, to the Secretary
of the Board of Health.
The instructions must be rigidly car-ried
out or the examination cannot be
made.
Disinfection and Prevention in tbe
Siek-room.
BY CHARLES HAKKINGTOX, .M. D., BOSTON.
Upon the discovery that he has to deal
with a case of one of the diseases com-monly
denominated contagious, the phy-sician
directs that the patient be iso-lated,
and that so far as is possible all
infectiotis matter be so treated that it is
robbed of its power to work injury to
others. Whether the results of his fore-sight
will be what they should be or a
jjositive injury is largely dependent upon
the care and thoroughness with which the
preventive measures are instituted and
carried out, for it can hardly be denied
that half-way meai^ures or the unintel-ligent
carrying out of proper directions,
with the consequent lulling into a sense
of safety, may be productive of as much
harm as absolute neglect of all precau-tions
other than those dictated to one
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
and anollier individual by a knowledge of
possible personal danger.
The measures recommended for safe-guarding
the health of others in time of
sickness comprise isolation, prevention
of dissemination of infectious material,
and disinfection, and these, I predict,
will lie enforced at no distant day by
all intelligent communities not alone in
the so-called contagious diseases, but in
all diseases of a serious nature spread
directly or indirectly by any of the ex-cretory
products of the body. Out of
deference to the controversy over the
right of the two words infectious and
contagious to have separate and distinct
meanings, I will here declare the sense
in which I employ them. Infectious dis-eases
include all those which depend upon
the presence of micro-organisms in the
tissues, while the contagious class of in-fections
diseases includes those trans-missil)
le from man to man by direct
contact or close proximity. We do not
commonly reckon typhoid fever, for in-stance,,
as a contagious disease, but when
we read that of 206 cases of that disease
investigated by Dr. Herbert Peck, 28, or
13.6 per cent., were traced to direct in-fection
in the sick-room, we must agree
witJi him that the danger is more com-mon
than is generally supposed, and that
it lias not received the attention that it
deserves. Lobar pneumonia and pulmon-ary
tuberculosis are also not included
in tjie contagious class, and yet we are
not insensible of the fact that house
epidemics of the former are not uncom-mon,
and that the latter is largely spread
by overcrowding and lack of ventilation.
It is not my intention to enter here
upon any discussion of the important
question of the advisability of enforcing
wkat may be regarded as unnec'"«sarily
liarsh measures for the suppression of tu-berculosis,
nor to touch upon the exten-sion
of supervisfon by public authority of
the handling of the sick, but rather
to consider the efficiency of preventive
measures already practised.
Isolation.—The object of isolation is
to remove tlie patient as completely as
possible from all chance of acting as a
menace to the health of others, whether
dwelling beneath the same roof or not.
In the dwellings of the poor it is usually
most difficult and frequently impossible
to isolate the patient in a proper man-ner
because, primarily, of lack of space;
in the homes of the well-to-do and of
the rich, where plenty of room is avail-able,
it is not uncommonly the case that
isolation is a mere farce because of fail-ure
on the part of the family to grasp
the full importance of thoroughness, in
spite of instruction by the attending phy-sician
and by the representative of the
local authority. In the minds of many,
isolation is complete when the patient is
in a room by himself, with the door lead-ing
therefrom into the hall open or shut
according to no particular rule, but ac-cording
as accident has left it. To such
minds the air of a sick-room is a deadly
contagion to which the doorway, not
the door, opposes itself as a most effi-cient
barrier. We all have met and
know the person well who says, "I was
very careful not to enter the room, but
talked with him from the doorway."
Often the door is left open, and its place
is taken by a sheet wetted occasionally
by some disinfectant solution. To this
thin obstacle, with more or less of open
space below and at the sides, the mor-bific
agents supposedly in the air are
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
presumed to attach themselves as the
natural processes of ventilation set the
air in motion from the room outward ; or,
if not this, the agent with which the
sheet has been wetted, perhaps hours
ago, is supposed to exert a purifying in-tiuence
upon every particle of passing
air. Under either of these conditions,
if infective matters are floating in the
lir of the sick-room there is no reason
.vhy they should not he carried to all
parts of the house. Even shutting the
door may not accomplish all tnat is de-sired
in respect of preventing efflux of air
from the sick-room to other parts of
the house, as can be shown by a most
simple experiment. Between the bot-tom
of the door and the threshold there
is usually a fair-sized interval through
which under the ordinarily existing dif-ferences
of temperature, and, therefore,
of density, a constant stream of air is
passing inward or outward. If one holds
a lighted match near this space, the
flame, if the air is in motion, is in-clined
one way or the other according
as the leakage is away from or toward
the room. Sometimes the current is so
strong that the match is extinguished.
This may seem to be a small matter, or,
indeed, insignificant, but under some cir-cumstances
it may well be thought
worthy of some extra care, in which case
sand-bags, such as are used on window
sashes, may be found serviceable.
In those cases in which aerial infection
is supposed to occur the ideal place for
isolating the patient is an upper floor or
an L which can be shut off" entirely from
the rest of the house, and ventilated
thoroughly by direct communication with
the outer air. Where such an area is
not available, the room should be closed
as completely as possible, and the im-mediately
adjoining rooms should be
kept well aired. In the class of cases
in which aerial infection under ordinary
careful attention to the excretory pro-ducts
is not to be expected, such exten-sive
inecautionary measures are not nec-essary,
and here the main points to be
considered are the prevention of dissemi-nation
of infective material and the best
method for the immedaite destruction of
the morbific agents as they are yielded
by the patient.
Frcvention of Dissemination.—It is
quite unnecessary to dwell upon the pre-cautions
always observed by careful, ex-perienced
practitioners against the car-riage
of infective material by themselves
from the sick-room, but it may not be out
of piace to mention the carelessness dis-played
by the thoughtless but enthu-siastic
beginner whom we all have seen
leaning down upon the mattress and bed-clothes,
supporting himself by his hands,
examining whatever attracts his atten-tion,
whether it be the body of the pa-tient
or the vessel containing the excre-tory
products, and ever and anon strok-ing
with his now possibly infected hands
his hair and beard, or rubbing them
against his own clothing or that of his
neighbor, or hiding them in his pockets.
Such carelessness on the part of the
nurse in attendance would be contrary to
licr training, and on the part of the stu-dent
or young practitioner is equally con-trary
to the instruction which he is sup-posed
to have received. Absolute care in
tins particular is imperatively necessary
on the part of all who visit or are in at-tendance
in the sick-room.
In preparing the room for the recep-tion
of the patient, it should be borne in
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
mind that the less furniture there is
present, the less there will be to undergo
the process of disinfection on the ter-mination
of the sickness. Above all, the
carpet should be removed at the very
outset, and all upholstered furniture
and draperies with it. Ordinary dusting
and broom sweeping, which stir up the
dust so thoroughly, should be absolutely
interdicted, and cleaning and wiping
with mops and cloths not wet, but well
moistened with a disinfectant, should
be substitiited.
The used bed linen, the patient's body
linen, the napkins, towels and other
cloths that may become infected may be
put to soak in disinfectants at once and
on the spot, or may be placed within cot-ton
bags wet with disinfectant, and con-veyed
at the proper time to the kettle,
into which, without further handling
and without opening, the whole is placed
and then boiled for an hour.
The uselessness of attempting aerial
disinfection in the presence of the pa-tient
is not apparently as well recognized
as it should be. The placing of small
amounts of chloride of lime, carbolic
acid, iodine, sulpho-naphthol anu other
disinfectants in saucers and other open
dishes, and distributing them about the
room, has no other effect than the pro-duction
of odors which may be an annoj--
ance to the patient. If disinfection could
be so easily accomplished, the local
boards of health would be relieved of
much work and very large expense. With
the agents at present available for ger-micidal
action, aerial disinfection in the
presence of the patient is absolutely im-possible,
for they must be used in such
concentration as- to be quite irrespirable.
But we must not overlook the disinfect-ant
power of direct simlight and the
beneficial effects of constant dilution of
the impurities of the air by proper ven-tilation.
The latter is materially as-sisted
l)y the maintenance of an open
tire when climatic conditions will not
permit cross ventilation by means of
open windows, and thus practical utility
and the conferring of cheerfulness are
combined.
The attention on the part of the nurse
to hands, hair, clothing, etc., and the
frequent necessity of providing separate
outfits of eating utensils for the patient,
and of destroying all unused portions of
his meals, need no more than passing
mention.
Disinfection of the Excretory Products.
—The materials which require thorough
disinfection include those from the
mouth, throat and nose in diphtheria
and whooping-cough ; from tne lungs in
influenza, pneimionia and plumonary tu-berculosis;
from the skin in the acute
exanthemata, especially during desqua-mation:
vomitus in yellow fever and,
conditionally, in other diseases; stools in
cholera, dysentery, typhoid fever and tu-bercular
conditions of the alimentary
canal ; and the urine in typhoid fever,
and perhaps, also, in some of the exan-themata.
These may be destroyed in
two ways, according to circumstances.
Those in not too large bulk and not too
iluid, such, for example, as sputum and
discharges from the nose, mouth and
throat, received on cloths, may be most
effectually disposed of by burning, if
tliere is a fire immediately at hand.
Bulky matters, stich as stools, urine and
vomitus, and objects actually or possi-bly
infected by them, such as bed-cloth-ing,
body linen, etc., which must be puri-fied,
but not destroyed, must be brought
into intimate contact with some disin-
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
fectant which fultllls the requirements of
a good germicide, namely, that it shall
kill all forms of bacteria and spores
within reasonable limits oi time, shall
not lie made inert by organic matters
with wiiich the bacteria are associated,
and shall not subject the attendant to
any dangerous consequences. If, in ad-dition,
it be cheap, free from disagreeable
odor, and incapable of injuring cotton,
linen and other textiles either by caus-ing
stains or by reducing their strength,
so much the better. Where shall we find
such an agent ? Shall we find it in the
shops put up in pints and quarts with at-tractive
labels which reveal or not, ac-cording
to the maker's fancy, the nature
of the acti\e ingredient ? No, we are not
likely to find it there; at least, that is
my experience.
In IMarch last Dr. Richard M. Pearce
and myself reported at a meeting of the
Boston Society of Medical Sciences the
results of our examinations of such pro-prietary
disinfectantsj as we could find
in the apothecary shops of Boston, and
it may not be out of place to report them
again in condensed form at this time,
for the brands obtained and examined in-clude
several that are held in high es-teem
by the profession generally. The
list included the following: Marsh's In-stantaneous
Disinfectant, Disinfectine,
Ozonos, Bromochloralum, Royal Disin-fectant,
Excelsior Disinfectant, Phenol
Sodique, Hovey's Chloride of Zinc, Piatt's
Chloride, Carbolic Purifying Powder, and
Solution of Chlorinated Soda. These weie
tested with anthrax spores, typhoid cul-tures,
typhoid stools, diphtlieritic mem-brane
and tuberculous sputum. The
mixlure of material and disinfectant was
intimate, and the length of time of the
contact was in each case two hours. So
far as demonstrating efficiency is con-cerned,
the results were distinctly disap-pointing,
for but one of this list was suc-cessful
in more than half of the ten tests
to which each was subjected, and this one
failed in three. One of them failed eight
times, another nine times, and three
failed every time. Not one of them was
successful in sterilizing the tuberculous
sputum. Those which failed in all the
tests were Carbolic Purifying Powder,
Koyal Disinfectant, and Phenol Sodique.
Those that failed eight and nine times,
were, lespectively, Hovey's Chloride of
Zinc and Bromochloralum.
In justice to the makers of these pre-parations,
it must be said that in no
sense can any of these disinfectants be
properly classed as a fraud, for chemical
analysis shows tnat they are one and
all composed of substances that are gen-erally
regarded as disinfectants, and are
so leccmmended in many of our stand-ard
works on public health. The sub-stances
found include chloride of zinc,
cliloride and sulphate of aluminum, alum,
permanganate of potassium, salts of
lead, iron and copper, neutral tar oils,
hydro-chloric and nitric acids, and others.
We must, therefore, believe that they are
manufactured and sold in good faith.
But even so, we cannot use disinfectants
that kill almost every time, or that kill
only occasionally; they must kill every
time, and we must therefore look else-where.
Shall we use corrosive sublimate? Its
action on many substances with which it
may come in contact, the readiness with
which it is thrown out of solution made
inert by matters associated with the bac-teria,
and its very poisonous character,
6 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
make this agent unreliable for general
purposes and undesirable. Shall we use
caustic lime? Lime is a good disinfect-ant,
but it has its disadvantages. It
must be used in the freshly slakfed state;
it must be applied in very considerable
amounts; it must be very intimately
mixed with the material to be disinfected,
for it is not very capable of self-mixing;
and after it has periormed its office, it
must be disposed of in such a way as to
cause no trouble. How to ao this in a
city block may be quite a problem. One's
first impulse would suggest throwing it
into the water-closet, but such disposal
would simply create work for the
plumber, for the pipes would soon be oc-cluded.
Moreover, lime cannot be used
for purifying linen and otner textiles.
Chlorinated lime is open to all the ob-jections
that apply to lime, and the ad-ditional
one of having a very disagree-able
odor. Where, then, shall we turn ?
In addition to the agents already men-tioned,
we tried a five-per-cent. solution
of carbolic acid, sulpho-naphthol, and a
somewhat similar substance which I will
designate solution B, both in five-per-cent,
strength, and two-and-one-half-per-cent.
solution of formalin, one per cent,
formaldehyde. Of these the first-men-tioned
has for years been a favorite
stand-by, objectionable to some on ac-count
of its odor, and recommended for
general purposes in two, three and five-per-
cent. strength. It killed the bacilli
in the sputiun, but was successful only
once in five trials with typhoid cultures
and stools and diphtheritic membrane.
The sulpho-naphthol solution, which can-not
be praised for its odor, was also suc-cessful
with sputum, and it supra ssed
the carbolic solution in efficiency by scor-ing
two successes in five other trials. The
remaining two preparations were uni-formly
successful, though it must be said
that they were tried only six times each,
twice with typhoid cultures, twice with
typhoid stools, and once each with spu-tiun
and membrane. Our previous in-vestigations
with formaldehyde, however,
seemed to us to make further tests un-necessary,
and as to the solution B, it
has a most disagreeable odor and is,
moreover, a patented article. I will not
mention its true name because I have no
doubt as to one use to which this paper
would be put, and because I have no de-sire
to have even the appearance of
writing •'reuling notices. I have no
hesitation in mentioning formaldehyde,
even thoug'i an enterprising concern in-terested
in its sale makes it a practice to
reprint, without permission, any articles
which nay serve its purpose. All for-maldehyde
is good, however, and, so far
as I know, that sold by one is no better
than that furnished by another.
Formaldehyde possesses all the quali-fications
of a good disinfectant, as men-tioned
above. In diluted form it has no
lurpleasant odor, it causes no injury to
fabrics, it makes no stain, it is not as
expensive as the cheapest of the proprie-tary
preparations, and, most important,
it kills every form of micro-organism
with which it is placed in direct con-tact.
I do not wish to be understood as as-serting
that there are no other efficient
disinfectants than formaldehyde, but it
happens that I cannot speak of them
from the stand-point of personal experi-ence.
Doubtless there may be others as
good, but it would be difficult to con-ceive
a superior. Ten years ago Frankel
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
demonstrated the superiority of the cre-sols
over carbolic acid, and within the
past two years a number of preparations
containing them in their variousisometric
forms and in various combinations have
been phiced upon the market. They liave
been extensively studied, and the origi-nal
conclusions of Frankel ha^-e been
confirmed again and again, but the most
favorable reports tlius far published pre-sent
no results which entitle them to ad-mission
to the class with formaldehyde.
A recent j^^^^lication by Seybold, who
investigated and compared a number of
aifferent preparations, shows that not
one of them is effective against anthrax
spores, whicn we know are quickly de-stroyed
by formaldehyde. It is but fair
to add that solution B, which we found
to be so successful with stools, mem-brane
and s;^putum, contains a consider-able
percentage of cresols.
Besides the cresols, various other or-ganic
substances have been extensively
exploited within recent times, but each
one seems to fail in some one or more
particulars.
Whatever tlie disinfectant used in the
sick-room, its application must be in no
niggardly amount, for in practical dis-infection
extravagance is a greater vir-tue
than too strict economy. The in-fected
objects should be submerged in the
solution so that the agent shall come
into contact with the entire mass. In
the case of stools, urine and vomitus,
at least an equal volume of the disin-fectant
sliould be added and the wliolc
should be carefully mixed. Although
in the case of formaldehyde the destruc-tion
of the organisms is accomplished in
a much shorter time, it is best to con-tinue
the exposure for about two hours,
thus erring, if at all, on the side of
safety. At tlic end of two hours, the
sterilized excretory matters may be fin-ally
disposed of by way of the water-closet,
and the bed linen and similar ar-ticles
sent to the wash-tub. There
seems to be no particular and good rea-son
for supplementing complete destruc-tion
of pathogenic organisms with any
further process of disinfection, but if it
suits one's ideas of necessity, the cus-tomary
prolonged boiling can, at least,
do no harm.
—
Boston Medical and Hurgi-cat
Jonrrutl in Sanitorian.
Review of Diseases for February, 190^.
XI.\ETY-OXE tOlXTIES REPORTI.XG.
Ninety-four counties have Superinten-dents
of Health.
Except in the case of the more conta-gious
and dangerous diseases the Super-intendent
has, as a rule, to rely upon his
own information alone, since few phy-sicians
can be induced to report oases of
non-contagious diseases to him.
Where the number of cases is not given
or the prevalence of a disease otherwise
indicated, its mere presence in the county
is to be understood as reported.
For the montli of March ihe follow-ing
diseases have been reported from the
comities named
:
Measles.—Allegliany; Beaufort, two
cases; Bertie, many; Brunswick; Cas-well,
several ; Clevehmd, a few ; Cum-berland,
a few; Durham, a great many;
Cranvillc, 12; Harnett, a few; John-ston,
several: Mecklenburg, 10; Moore,
several; New Hanover, 1; Onslow, 10;
Orange, a few; Person; Eandolph, a
few; Richmond, in all parts; Kobeson;
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Rockingham: Rowan, C; Scotland, many;
Surry, 6; Swain; Union, 10; Wake. 2;
Wilkes, (5—28 connties.
Whoopixg-cough.—Beaufort, 2 : Bruns-wick;
Caswell, several; Cleveland, a few;
Davidson; Durham; Granville, 15; Har-nett,
a few: Hertford; Hyde. 50; John-ston,
several; ^Mecklenburg; Moore, a
few; Northampton, many; Perquimans,
12; Person, many; Randolph, a few;
Rutherford, a few; Sampson, in all
parts; Scotland, several; Union, 20;
Wake, 2—22 counties.
Scarlet Fever.—Alleghany; Ashe, 3;
Buncombe, 2; Caswell, 3; Catawba, 2;
Stanly, 6; Watauga, 6—6 counties.
Diphtheria.—Ashe, 5 ; Bladen, 1
;
Craven, 1; Cumberland, a few; Lenoir.
2; New Hanover, 1; Rockingham; Ruth-erford,
2; Wake, 1; Wayne. 1—10 coun-ties.
Typhoid Fe\'er.—Ashe, 1 ; Cleveland,
2 or 3 ; Columbus, 2 ; Craven, 1 ; Gates,
1 ; Granville, 4 ; Greene, 1 ; Harnett, a
feW; Johnston, 1; Jones, 1; Nash, 2;
Onslow, 1; Polk, 2; Randolph, 3; Rock-ingham;
Rowan, 2; Stokes, 1; Swain, 3;
Union, 12; Wake, 4; Watauga, 4—21
counties.
Malarial Fever.—Bladen, Caswell,
Chowan, Greene and Halifax.
Malarial Fever, Pernicious.—Bla-den,
2.
;Malari.\l Fever, Hemorrhagic.—
Chowan, 1 ; Greene, 1.
IxFLiEXZA.—Bladen, general; Bruns-wick;
Caswell; Columbus; Da\adson;
Gatpp; Graham; Greene; Henderson ;Hert-ford.
general; Iredell, a few; Lincoln,
general; Montgomery; New Hanover;
Northampton, general: Onslow, a few:
Orange, general; Person; Robeson;
Stokes; Transylvania; Yancey—22 coun-ties.
Pneumonia.—.\lexander; Bladen, in all
parts; Burke; Caswell; Chowan; Clay, in
all parts; Gates; Graham; Greene, in
all parts; Guilford; Halifax; Harnett;
Hj'de, in all parts ; Iredell, 1 ; Montgom-ery,
15; Moore, in all parts; Perqui-mans,
4; Person; Polk; Randolph; .Samp-son,
in all parts; Transylvania; Union;
Yancey—24 counties.
Mumps.—Alexander, in all parts; Al-leghany;
Davidson; Person; Rocking-ham,
in all parts; Scotland; Washing-ton,
in all parts; Watauga; Wayne,
several; Wilkes; Yadkin—11 counties.
Rheumatism.—Columbus, more than
usiial.
V.vricella.—Davidson; Lenoir; Pen-der,
1; Wilson, 1.
Small-POX.—Buncombe, 5; Burke, 2;"
Cabarrus, 9; Caldwell, 2; Cherokee, 3;
Cleveland, 2; Cumberland, 1; Durham, 2;
Forsyth, 3; Franklin, 4 (?); Gaston, 27;
Graham, 9, Greene, 1, from Wilson
—
"There have been no cases in the region
infected a year ago" ;Henderson,l; Iredell,
a number among negroes in the eastern
part; Johnston, 1; Lenoir, 1, none now
(April 9) ; Lincoln, 5, last case dis-missed
March 26; Mecklenburg, 35;
Nash, 5; New Hanover, 1; Richmond, 3;
Rockingham, 3; Rowan, 5; Rutherford,
2; Sampson, 2; Stanly, several, all now
discharged (April 8); Wilson, 69, 4
deaths—28 counties.
Cholera, ix Hogs—Chowan, Hert-ford.
Infll'enza, IX Horses.—Polk.
Rabies, in Dogs.—Iredell.
Staggers—Hvde.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 9
Xo diseases of importance reported
from Alamance, Anson, Carteret, Curri-tuck,
Davie, Duplin, Edgecombe, Hay-wood,
McDowell, Madison, Martin, Pas-quotank,
Pitt. Vance and Warren.
No reports from Chatham and Mitchell.
The Rocky 3Ioiiiitaiu Iiiclnstrlal
Sauatorlnin.
Before the organization of this institu-tion
was perfected we expressed our ap-preciation
of the probable usefulness of
the projected sanatorium. We have
.since had gratifying accounts of its pro-gress,
and we now learn that it is well
advanced in its actual work. A card re-cently
issued bears the statement that up
to the time of the publication of the
card, which is not dated, forty-four pa-tients
had been cared for, of whom thir-teen
had been wholly and eleven partly
self-supporting. The existence of an in-stitution
in which such results have al-ready
been accomplished seems to us to
add materially to the resources within
the reach of those subjects of incipient
tuberculous lung disease who lack the
means of paying in full the cost of their
maintenance and treatment, and we hope
the day is close at hand when such re-sources
will be vastly multiplied.
A scheme has recently been announced
which promises to augment considerably
the availability of this particular sana-torium
for certain classes of persons,
namely, the organization of what is
termed the Sanatorium Press Auxiliary,
The plan involves the publication of "a
magazine to ije the organ of the .sena-torium,
and to furnish its readers with
information as to matters pertaining
to the maintenance and restoration of
health. It is proposed ihat all the work
of preparing the magazine, "e.xcept the
actual handling of the issue after it
comes ii'om the press," shall be done
l»y persons who are under treatment in
the sanatorium. Such an arrangement,
it will be seen, seems to carry with it
the opportunity for many a poor writer,
illustrator, compositor, proof-reader, or
jiressman to lake the treatment rccpiired
liy Ills impairment of health, without a
total loss of income. It will, of course,
take time for this scheme to l)e put into
actual operation, for a special building
and a complete printing plant will have
to be provided. We presume that all
that is expected of the magazine is that
it will pay expenses, account being taken
of the prestige it may serve to give the
sanatoriiun, and it ought not to l)e very
difficult, we should think, to hit upon
similar plans that would benefit workers
in various other lines than that of litera-ture.
That, in deed, seems to be the es-sential
feature of an industrial sana-torium,
and the community will expect to
see it carried otit as completely as possi-ble,
regard always being paid to the avoid-ance
of unfair competition with the regu-lar
trade on the strength of having been
able to obtain "lungers* " labor cheap.
We feel sure that the managers of the
Kocky Mountain Industrial Sanatorium
will not make the mistake of following
any other course, and we shall look with
much interest for the results of their
venture.
—
Xeic York Medical Journal.
Summary of Mortnarj- Repoi-ts for
Marcli, 190-J.
(twexty-nine towxs).
Aggregate popula- White. CoVd. Total.
tion 92,800 61,750 154,550
Aggregate deaths.. 134 117 251
Representing tem-porary
annual
death rate per
1,000 17.3 22.6 19.6
Causes of Death.
Typhoid fever 3 2 5
Scarlet fever 10 1
Whooping-cough... Oil Measles . 1 I
Pneumonia 29 23 52
Consumi>tion 21 21 42
Brain diseases 5 2 7
Heart diseases 10 9 19
Neurotic diseases... 3 14 Diarrhceal diseases 2 13 All other diseases.. 56 51 107
Accident 3 2 5
Suicide 1 I
Violence 3 3
]:'.4 117 251
Deaths under five
vears 23 33 od
Still-born 1 » y
10 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
I^ortuary Report for JMarch, 1902.
Towns
AND RePOKTEBS.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 11
County Superintendents of Healtli.
Alamance Dr. H. R. Moore.
Alexander Dr. C. J. Carson.
Alleghany Dr. B. C. Waddell.
Anson Dr. J. H. Bennett.
Ashe Dr. J. W. Colvard.
Beaufort Dr. Jno. G. Blount.
Bertie Dr. H. V. Dunstan.
Bladen Dr. L. B. Evans.
Brunswick Dr. J. A. McNeill.
Buncombe Dr. E. B. Glenn.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. A. A. Kent.
Camden
Carteret Dr. F. M.Clark.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. H. T. Chapin
Cherokee Dr. J. W. Patton.
Chowan Dr. T. J. Hoskins.
Clay Dr. J. O. Nichols.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr. N. li. Street.
Cumberland Dr. Jno. D McRae.
Currituck Dr. H. M. Shaw.
Dare .Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James McGuire.
Duplin Dr. O. F. Smith.
Durham Dr. N. M. Johnson.
Edgecombe Dr. L. L. Staton.
Forsyth Dr. John Bynum.
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. 0. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. D. Booth.
Greene Dr. Joseph E. Grimsley.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. Green.
Harnett Dr. O. L. Denning.
Haywood Dr. S. B. Medford.
Henderson Dr. J. G. Waldrop.
Hertford Dr. J. H. .Mitchell.
Hyde Dr. E. H. Jones.
Iredell Dr. Henry F. Long.
Jackson Dr. Wm. Self.
Johnston Dr. L. D. Wharton
Jones Dr. S. E. Koonce.
Lenoir Dr. C. L. Pridgen.
Lincoln Dr. T. F. Costner.
McDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. S. McLaughlin.
Mitchell Dr. V. R. Butt.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. D. C. Parris.
Pamlico
Pasquotank Dr. J. E. Wood.
Pender Dr. R. J. Williams.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing
house.
Polk Dr. Earle Grady.
Randolph Dr. S. A. Ilenlev.
Richmond Dr. Wm. P. S. Webb.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford Dr. T. B. Tvvil y.
Sampson Dr. R. E. Lee.
Scotland Dr. A. W. Hamer.
Stanly Dr. V. A. Whitlev.
Stokes Dr. W. V. McCanlesa
Surry Dr. John R. Woltz.
Swain Dr. J. A. Cooper.
Transylvania Dr. C. W. Hunt.
Tyrrell
Union Dr. John M. Blair.
Vance Dr. Goode Cheatham.
Wake Dr. J. J. L. McCullera
Warren Dr. A. S. Pendleton.
Washington Dr. W. H. Ward.
Watauga Dr. T. C. Blackburn.
Wayne Dr. Williams Spicer.
Wilkes Dr. W. P. Horton.
Wilson Dr. W. S. Anderson.
Yadkin Dr. M. A. Royall.
Yancey Dr. J. L. Ray.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 13
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board.
Have any of the following diseases occurred in your practice during the month
just closed. If so, state number of cases.
Whooping-cough — Typhoid Fever
Measles Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever -- Cerebro-spinal Meningitis-
What have been the prevailing diseases in your practice?
Has any epidemic occurred among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks:
M, D.
.190-— N. C.
:B"criLiL:ETii>T
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G. Thomas, M. D., Pres.,AVilmington.
S. Westray Battle, M. D...Asheville.
Henry W. Lewis, M. D Jackson.
J. L. Nicholson, M. D Richlands.
W. P. IvEY, M. D Lenoir.
Francis Duffy, M. D New Bern.
\V. H. Whitehead, M. D Rocky Mt.
J. L. Ludlow, C. E Winston.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh
Vol. XVII. MAY, 1902. No. 2.
Meeting of tbe Board.
The annual meeting of the Board will
as usual be held at the same time and
place as that of the State Medical So-ciety,
which this year will meet at Wil-mington,
-June 10—13. The conjoint ses-sion
with the Medical Society will as-semble
at 12 M. Wednesday 11th. It
is very much to be desired that all the
health officers of the State should get
together at least once a year, and we sin-cerely
hope that every superintendent of
health in the State will exert himself to
be present. The meeting promises to be
an interesting and enjoyable one, and we
feel sure that those who attend will be
fully repaid fur the trip.
Bovine Tuliercalosig.
Since Koch's expression at the London
Tuberculosis Congress of the opinion that
tuberculosis in man and tuberculosis in
the cow were not the same disease and.
therefore, non-transmissible from one to
the other, the question has excited the
greatest interest. It is still suh judice,
however, and practical health officers
have thought it wisest to continue their
work on the supposition that it is trans-missible
from cow to man. In this con-nection
our Biologist, Mr. McCarthy of
the Department of Agriculture, has made
a bacteriological test for tubercle bacilli
of sixty-seven samples of milk from
dairies in all parts of the State. In only
one in.stance did he find the bacillu.s and
it was absent from a secoml sample from
that herd. A tuberculin test of the herd
demonstrated its freedom from tubercu-losis.
The first sample must have been
infected accidentally from outside. This
sjieaks well for our milk supplies, but
it would be more satisfactory to know
that the dairy herds had stood the tuber-culin
test successfully. Some years ago
we advised that all cities and towns for-
16 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
l>id the sale of milk within their limits
from infected herds, but it met the fate
of much good advice even from higher
sources. If the question should be set-tled
against Koch we promise ourself to
make another move on that line.
Mr. McCarthy desires us to state that
he will probably take his vacation in
June, in which event the biological labo-ratory
would be closed during that
month, as he has no assistant, unless one
should be provided by the Board of Agi-i-culture
at its meeting on May 27th. We
hope that some arrangement may be
made to prevent a hiatus in the work.
The Emibalmer in His Relation to
Infections Diseases.
Read before the State Funeral Directors' and
Einbalmers' Association, May 14, 1902,
BY RICHARD H. LEWIS, M. D.,
Secretary North Carolina Board of Health.
The prime object of the State, through
its General Assembly of 1901, in creating
the State Board of Embalming was the
protection of the public health. This is
shown by. the fact that the majority of
the Board were required to be members of
the State Board of Health. At the same
time the claims of the embalmer's calling
were recognized in making two of the
five members "practical embalmers."
And this is as it should be, for while I
would not minimize in the least the na-tural
and praiseworthy sentiment of rev-erence
for the dead, it still remains that
the only practical value to the living of
the art of embalming consists in prevent-ing
to some extent the spread of infec-tious
and contagious diseases by the
prompt destruction in the dead botly of
the germs which cause them. The re-sponsibility,
therefore, resting upon the
embalmer called to prepare, for transpor-tation
especially, the remains of one dead
of an infectious disease is very great.
And this responsibility is shared by the
Board of Embalming, and through it by
the State Board of Health likewise, inas-nuich
as the license to perform this im-portant
work is derived from them. The
realization of this responsibility on the
part of the two boards, of both of which
1 happen to be a member, accentuated by
my experience in the examination of ap-plicants
for license to practice embalm-ing,
is the reason for my presenting this
paper to your honorable association.
From the answers given by some of the
applicants to questions bearing upon dis-infection
it was very apparent that the
instruction received by them on that sub-ject,
from some at least of the teachers
of embalming, was very faulty and ut-terly
inadequate—the process recom-mended
amounting to no disinfection at
all. Disinfection to be effective must be
very thoroughly done, no detail, how-ever
small, being omitted.
While it might be claimed by the em-balmer
that his duties cease witn the dis-infection
and embalming of the corpse, as
a matter of fact he is in many instances
practically the only one available to dis-infect
the room and its contents, and a
thorough knowledge of the best methods
is therefore justly demanded of him, even
if he should refuse to do the work. But
of course no embalmer of the right spirit
would decline if called upon by the
family to do it. Indeed, I very much
hope that not only all licensed embalm-ers,
but all undertakers as well, will fit
themselves by the acquirement of the
necessary knowledge and apparatus for
doing this work. In a large majority of
cases of death from infectious disease the
BULLETIN OF. THE NORTH CAROLINA BOARD OF HEALTH. 17
body is not embalmed, and only the
work of the undertaker is in demand,
but the necessity for the thorough disin-fection
of the remains and of the room
and of all its contents remains the same.
There is no reason why every imdertaker
should not be a skilled disinfector,
thereby adding to his own income and
at the same time doing a valuable ser-vice
to his community. I would be glad
to see the word ''Disinfector" added to
the business sign of every funeral direc-tor
in the State. A total outlay of less
than twenty dollars would provide every-thing
necessary in the way of apparatus
and materials: a disinfector's suit (or-dinary
overalls, with coat well buttoned
and collar turned up, trousers long and
wide enough to cover the feet, and a few
yards of cheese cloth to envelope Ihe
head, neck and lower part of the face,
leaving only the eyes exposed, would an-swer
very well) ; a Lentz formaldehyde
generator ( I recommend the Lentz merely
because it is the cheapest of its class,
and good enough) ; a supply of formalin,
bichoride of mercury and carbolic acid;
and a book of instructions. I can cor-dially
recommend an excellent little man-ual
entitled "Disinfection and Distin-fectants,"
prepared by my friend, Dr. H.
^I. Bracken, Secretary of the State Board
of Health of Minnesota, and published by
the Trade Periodical Company of Chicago
at a cost of $1. The subject we have un-der
consideration is so well treated by
Dr. Bracken that I feel that I cannot do
better than to quote liberally from his
book—as I now proceed to do:
THE DISINFECTOR.
"\^Tien the time comes for the disin-fection
of the sick-room and its occu-pants,
a most important duty is to be per-formed
in order to protect the general
public, and none but trained and con-scientious
disinfectors should be en-trusted
with this duty. Unfortunately,
it too often happens that when the plTy-sician's
duties cease, those of the under-taker
begin. It is certainly important,
therefore, that he should know what to
do and liow to do it, for by doing the
right thing he not only protects him-self,
but the public at large. It may
be that it is necessary for him to give
immediate attention to the remains of
the dead. If so, his suit should be
moistened and put on and his mouth
and nose protected by some covering.
The remains should then be properly
washed with a disinfectant and injected
with a reliable disinfecting fluid.
"It is much better, when possible, after
death from small-pox, scarlet fever,
diphtheria, etc., to use formaldehyde as
an aerial disinfectant in the room where
tlie remains are lying before doing any-thing
with the dead body itself. When
this is not possible the greater care will
be necessary on the part of the under-taker
for the protection of himself and
others. After the remains have been
cared for the room and its contents must
be further disinfected by some competent
person—this may be a phjsician, a
trained nurse, a trained disinfector or
the embalmer. It is not often that a
physician is willing to do this work. In
many instances there is no trained nurse
or disinfector at hand. The embalmer
is undoubtedly the best one in many in-stances
to be entrusted with this work.
If he undertake the task, he should be
familiar with the responsibility resting
upon him and should perfoi'm his duties
as a disinfector conscientiously. First an
aerial disinfectant should be used in the
18 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
room and the best one is undoubtedly for-maldehyde.
After this formaldehyde disin-fection
the room should be entered;
all personal clothing and bedclothing
should be placed in an antiseptic solu-tion
prior to washing, or placed in a
pile for further treatment wdth formal-dehyde,
or burned. Carpets, furniture,
wood-work, walls, floors, etc., must be
disinfected as directed further on. Finally
the room must be freely aired out before
being again used for habitation.
SPECIAL DISINFECTION.
"1. Of Clothing.—All articles of cloth-ing
from the patient or his bed that are
not injured by soaking in a disinfecting
solution can safely be treated by boil-ing
or steaming, and such precautions
should always be taken. In fact, the
use of the disinfecting solution should be
looked upon as only temporary protec-tion,
to be depended upon only until
such time as disinfection by boiling or
steaming can be carried out.
"2. Of Rooms.—All windows and doors,
except one for the exit of the dis-infector,
should be closed and sealed
with strips of paper pasted OA-er the
cracks" (and the throat of the chimney
should be tightly closed by packing with
old grain bags, paper, or whatever will
surely prevent the escape of the gas, un-less
the fire-place is small enough to
permit its satisfactory closure by past-ing
a sheet of strong paper OA^er it).
"When all is in readiness to liberate the
disinfecting gas, the disinfector should
finally withdraw from the room, closing
tightly the door or AvindoAv from which
he makes his exit" (sealing its cracks
from the outside)
.
"\Yhen sulphur is "sed as the disin-fectant
the folloAving course should be
pursued: Place a large wash-tub par-tially
filled Avith boiling water in the
centre of the room. In this tub of hot
AA-ater place an iron kettle resting upon
bricks or some other solid substance. In
the kettle place a quantity of crushed
brimstone (ten pounds for each thou-sand
cubic feet of space) and pour over
this some alcohol (about four ounces).
When all is ready light the alcohol on
the sulphur and AvithdraAv from the room.
The water in the tub serA'es a double pur-pose:
(1) It protects from the danger
of fire spreading from the burning sul-phur
and alcohol in the kettle. (2) It
supplies moisture in the room—a neces-sity
Avith sulphur disinfection.
"In the use of formaluehyde as a disin-fectant
it is best to choose an apparatus
that can be operated from the outside
of the room, the gas being conducted into
the room through the key-hole or other
small aperture." (The articles in the
room should be so spread out and ar-ranged
as to permit the free access of
the gas)
.
"The room should be kept closed for
a period of at least five or six hours after
the introduction of the disinfectant.
"Further disinfection of the contents
of the room: After aerial disinfection
the contents of the room or house should
be divided into three groups:
" ( a ) Articles that can be disinfected by
boiling or Avashing.
'•(b) Articles that can be disinfected
by further treatment with formaldehyde.
"(c) Articles that must be burned.
"W'ashable clothing, sheets, etc., should
be placed for a time in a five per cent,
solution of carbolic acid in AA-ater." (A
one per cent, solution of formaldehyde
(one part of formalin to forty of AA-ater),
or a one to one thousand solution of
bichloride of mercury (in a icooden xes-
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 19
sel) would be equally as good). "They
should then be removed and boiled for
at least a half-hour.
"Certain articles, presenting a free sur-face
and not too thick, such as carpets,
blankets, curtains, etc., can be made com-paratively
safe by thorough disinfection
with formaldehyde. Furniture that will
stand washing, such as plain chairs, ta-bles,
bedsteads, etc., should be washed
with a solution of corrosive sublimate in
water, one part in one thousand. Up-holstered
fm-niture, mattresses, pillows,
feather beds, and all articles that would
be spoiled by such methods of disinfec-tion
as have already been described,
should be burned.
'•'Further disinfection of the room:
After the removal and disinfection of
the contents of a room the room itself
should receive careful attention. If the
walls are papered the paper should be
soaked off with a one to one thousand
parts solution of corrosive sublimate in
water, and the walls, windows, wood-work,
floors, in fact, everj-thing about
the room, should be washed with a simi-lar
solution. It is a good plan to re-paint
all woodwork." (Walls of a suit-able
character should be wliite-washed,
or caloomined).
"After everj-thing has been thoroughly
disinfected, still further precaution
should be taken by allowing the most
complete ventilation possible of the room.
Articles of clothing or furniture should
be placed in the open air and exposed to
the sunlight, if possible, for several
days.
"3. Of the Dead.—This is a very im-portant
duty; otherwise disease may be
spread far and wide. The remains of all
those who die of an infectious disease
should be thoroughly injected with a re-liable
embalming fluid; all external ori-fices
should be securely closed with ab-sorbent
cotton; and finally, the entire
surface of the body, including the hair,
should be thoroughly cleansed with a re-liable
disinfectant, such as a solution of
corrosive sublimate (one in one thou-sand
parts of water), or of carbolic acid
(one in twenty parts of water). With
such precautions taken the shipment of
bodies may be permissible as governed
by the rules given elsewhere.
"The importance of giving such careful
attention to the remains of all who die
of an infectious disease cannot be too
strongly emphasized.
"Often there is no wish to remove the
remains at the time from the place of
death to some remote point, and the
burial is made without thorough disinfec-tion
of the body. At some later period,
for some reason or other, the wish for re-moval
may arise, -but then it will be too
late, for the remains of one who has died
of dangerous infectious disease and
buried without proper disinfection im-mediately
following death, cannot be
safely disinterred.
"It maj' be well, while dealing with
this stibject, to state that very few of the
so-called disinfecting embalming fluids on
the market will stand the bacteriological
test. It is a difficult but not impossible
task to find an embalming fluid that has
both good disinfecting and cosmetic
qualities.
"Another important fact to bear in
mind in the use of embalming fluids la
the necessity of thorough injection. The
common tendency is to use an insufficient
quantity of fluid. Enough can be in-jected
only under pressure. Such pressure
shotild be constant, as secured from a
compressed air apparatus or the fountain
20 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
syringe or irrigator, placed with its bot-tom
at least six feet above the point of
insertion for the injecting canula or
needle. The bulb syringe can never be
a reliable instrument for use in embalm-ing."
I do not advise disinfection by sulphur
fumigation, for while it may be effective,
and is effective if sufficient sulphur is
burned in the presence of abundant mois-ture,
it is not altogether so certain as
formaldehyde, and besides has the serious
objection of bleaching colored fabrics, as
carpets, curtains, woolen clothing, up-holstered
furniture, etc., all of which can
be successfully treated with formalde-hyde
at the same time the room is dis-infected.
Disinfection with formaldehyde can be
accomplished by other methods than the
one indicated, as, for example, the
Chicago method of spraying sheets sus-pended
in the room ^\^lth formalin, or the
generation of the gas by the burning of
wood alcohol in various apparatus, as
the Kuhn generator, as well as in other
ways. On the whole, however, the
method recommended, that is, by the use
of generators of the type of the Lentz,
the Mulford, the Kny-Scheerer, the Parke,
Davis & Co. and the West, all of which
can be operated from the outside under
constant supervision, is in my judgment
the best.
I beg to express the hope—and for the
Board of Health and the Board of Em-balming,
the wish—that the methods
above set forth, which practically cover
the subject of disinfection in its rela-tion
to the embalmer and the under-taker,
be strictly observed by all mem-bers
of your calling, especially by all li-censed
embalmers. The Board of Em-balming
in granting license guarantees
to the people of our own State and of
other States the competency of its licen-tiates,
and it should therefore be assured
not only of the possession on their part
of the requisite knowledge of the sub-ject,
but also of the disposition to apply
it honestly and conscientiously. Of
course if it should appear that any li-censed
embalmer fails to meet these re-quirements
in his practice it would be-come
the painful duty of the Board to re-fuse
to renew his license.
The responsibility resting upon the em-balmer
and undertaker in relation to in-fectious
diseases is very great, but I am
confident that it is only necessary to
call attention to the grave importance of
the matter to insure the conscientious
performance of the duty.
Tent Liife for Consumptives.
As soon as the weather will permit
and proper locations can be selected
there will be pitched near Boston the
first of a number of camps for consump-tives.
This camp (and each succeeding
camp Avill be like it) will consist of ten-
2)iano-box tents, arranged in a circle
with an open-air fire in the center, and
surrounded by a duck wall eight feet
high. Each of these tents will be a con-sumptive's
home, a consumptive will sleep
there, even through the coldest weather^
with no other protection than plenty
of felt blankets, felt sleeping boots, and
a two-gallon jug of hot water.
The tents are made of twelve-ounce
duck, are only seven feet high, with four-foot
walls, boxed in around the bottom
a foot from the ground. They will be
lined with weather paper. The flaps will
open toward the fire, the ten tents mak-ing
a little circle about a clean gravel
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 21
court. Ill the duck Avail \vhich sur-rounds
the whole will be a single en-trance.
The people who live there will
wear one heaA-y suit night and day. They
will each of them take one quick soapless
bath a week, and will eat three good
hearty meals a day, with coffee in the
morning and hot chocolate any time of
the day or night. Their bill of fare
will include milk, eggs, vegetables, bread
and butter, and meat—chiefly beef, mut-ton,
or pork, broiled on spits before the
fire or roasted in the embers, or broiled
down into soup.
This open life is expected to cure them
of their disease. The method is the re-sult
of experiments made last winter in
a tent on Huntington avenue by a scien-tist
whose name has not yet been di-
A-ulged. This gentleman pitched his
tent during the coldest part of a Jan-uary
which was more than usually cold,
and stayed in there \intil the early
spring, engrossed in his experiments,
but finally seeing patients and announc-ing
that he wanted as many consump-tives
as possible to prove the truth of his
theories.
He wants the consumptives still. His
theory has been pretty well tested now,
but he still wants as many consumptives
as Avill come to him—the worse their
condition the better—to put them in his
settlements.
"The life there," he said, "quickly
fortifies a man's bodily powers; it en-volutes,
then evolutes man back toward
ancestral or wild life. The skin, nails,
and hair toughen and thicken; pul-monary
catarrh stops: hemorrhages
cease. A civilized man loses his sensi-tiveness;
his emotions change. He be-comes
insensitive and fearless. All his
energy goes to nutrition; his intellectual
centers are dormant. All his powers are
concentrated in building and repair. He
falls asleep at twilight and wakes at
dawn, ready to eat. Incidental disaster
affects him little; he changes from a
hothouse plant to an oak. The fear and
panic customary to a crowd of consump-tives
no longer affect him, and thus the
greatest danger of hospitalism is avoided.
"Baron Larry Nap, chief surgeon and
adviser, made this same observation in
his Egyptian and Russian campaigns:
that incipient consumptives make the
best soldiers. They have Spartan cour-age,
and army life, properly regulated,
will cure them. A regiment of consump-tives
would be no mean enemy."
The camps are merely for the purpose
of scientific investigation, and if a pa-tient
cannot a fiord the expenses he will
be taken free. The camps will all be
near the city, where scientific physicians
are within call.
—
Boston Transcript, in
loica Health Bulletin.
Review of Diseases for April, 190"3.
EIGHTY-SIX COUNTIES REPORTING.
Where the number of cases is not given
or the prevalence of a disease otherwise
indicated, its mere presence in the county
is to be understood as reported.
For the month of April the follow-ing
diseases have been reported from the
counties named
:
Measles.—Anson, several cases; Beau-fort,
epidemic; Bladen, 4; Brunswick,
many; Cabarrus, 4; Caswell, 50;
Chatham, many; Currituck, several;
Durham, many; Forsyth, many; Gran-ville.
25; Guilford, 2; Harnett, a few;
Johnston, many; Jones, several; Macon,
a few: Mecklenburg; Moore, several;
Randolph, a few; Rockingham, many;
Rowan. 5; Scotland, several; Swain, 15;
Wake. 14; Wayne, 1; Wilkes, 3; Yadkin,
2—27 counties.
22 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Whooping-cough.—Alamance, 30 ; Beau-fort,
10; Bertie, many; Cabarrus, 6; Cas-well,
50; Dare, 5; Da\'idson, several;
Durham, several; Granville, 8; Harnett,
a few; Hertford, 25; Hyde, 25; Meck-lenburg;
Montgomery, 25; Moore, a few;
Northampton, epidemic; Pasquotank, 2;
Pitt, in all parts; Randolph, general;
Sampson, a great many; Scotland, a
few; Stokes, 1; Union, 16—23 counties.
Scarlet Fever.—Catawba, 7; Guil-ford,
1 ; Mecklenburg ; Xew Hanover, 1
;
Rowan, 3; Watauga, 10—6 counties.
Diphtheria.—Bladen, 1 ; Catawba, 1
Lenoir, 1; Mecklenburg; Xew Hanover, 1.
Typhoid Fe\'er.—Chatham, many
Cleveland, 3 ; Columbus, 1 ; Gates, 1 ; Gra-ham,
4 ; Greene, 1 ; Guilford, 1 ; Har-nett,
a few; Montgomery, 2: Moore, 5;
Nash, 1 ; New Hanover, 1 ; Rockingham,
a few ; Rowan, 3 ; Scotland, 3 ; Stanly, 1
;
Vance, a few; Wake, 2; Watauga, 6
—
19 counties.
]VL\LARIAL Fever.—Bertie, Bladen, Cas-well,
Chowan, Cumberland, Currituck,
Dare, Gates, Greene, Hyde, Jones, Mar-tin,
Onslow, Person, Sampson, Union,
Vance and Wayne—18 counties.
Malarial Fe\'er, Pernicious.—Dare,
2; Jones, 1.
Malarial Fe\'er, HEiiORRHAGic.—Cho-wan,
1; Gates, 1; Greene, 1; Martin, 1;
Union, 5.
Bo^vEL Diseases.—Bladen, Catawba,
Gaston, Onslow and Pasquotank.
Influenza.—Brunswick ; Caswell, in
nearly all parts; Dare, several; Gates;
Pender, a few; Perquimans, a few; Ran-dolph,
in all parts; Stokes; Wake, in
all parts; Wilkes; Yadkin—11 counties.
Pneumonia.—Alexander, in all parts;
Anson; Bladen; Chatham, many; Curri-tuck,
1 ; Franklin, a few ; Gaston, 1
;
Gates, 3; Harnett, many; Haywood, seve-ral;
Lenoir; Perquimans, a few; Pitt, in
all parts; Randolph, in all parts; Vance,
in all parts; Wake, in all parts; Wayne,
Yadkin—-18 counties.
Mumps.—Davidson; Gram-ille; Iredell,
in all parts; McDowell, a few; Onslow,
a few; Person; Rockingham; Stanly;
Watauga; Wilkes—10 counties.
Varicello—Carteret, many; Sampson,
in nearly all parts.
Small-pox.—Beaufort, 1 ; Burke, 1
;
Cabarrus, 6; Caldwell, 1; Caswell, 3; Ca-tawba,
1; Davie, 1; Forsyth, 6; Gaston,
several; Guilford, 1; Iredell, 8; Lincoln,
1; McDowell, 3; Mecklenburg, 56; Nash,
7; Rockingham, 28; Rowan, 8; Ruther-ford,
2; Union, 1; Wake, 2; Wilson, 11;
Yadkin. 6—22 counties.
Cholera, in Chickens.—Clay, Gates
and Onslow.
Cholera, in Hogs.—Chowan.
Staggers, in Horses.—Currituck and
Hyde.
No diseases reported from Ashe, Bun-combe.
Clay, Duplin, Edgecombe, Gra-ham,
Henderson, Jackson, Madison,
Mitchell, Polk, Transylvania and War-ren.
No reports received from Alleghany,
Cherokee, Cleveland, Halifax, Orange,
Richmond, Surry and Washington.
Snnimarj- of Mortuary Reports for
April, 1903.
(twenty-seven towns).
Aggrec^ate popula- T^^^^-